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Comment & Response
May 9, 2019

Granulocyte Colony-Stimulating Factors in Therapy-Related Myelodysplastic Syndrome and Acute Myeloid Leukemia

Author Affiliations
  • 1Swedish Cancer Institute, Seattle, Washington
  • 2Department of Epidemiology, University of Washington, Seattle
  • 3Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago
JAMA Oncol. Published online May 9, 2019. doi:10.1001/jamaoncol.2019.0737

We read with interest the recent report by Morton and colleagues1 on the risk of therapy-related myelodysplastic syndrome (tMDS) and acute myeloid leukemia (AML). The observed increased incidence of this entity in patients with solid tumors who have received radiation and chemotherapy is consistent with other reports, including those of cancers presenting at a younger age.2 The authors call attention to the well-known chemotherapeutic agents related to the risk of tMDS/AML, including alkylating agents, topoisomerase II inhibitors, and platinum compounds.1 An accompanying editorial3 acknowledges the need for pharmacovigilance with respect to poly (ADP-ribose) polymerase inhibitors that also act adversely on the bone marrow. One point that deserves further discussion and study is the use of granulocyte colony-stimulating factor (G-CSF) to prevent complications from chemotherapy-induced febrile neutropenia.

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