Risk of hematologic malignancies after radioiodine treatment of well-differentiated thyroid cancer
Open accessAbstract
Purpose To investigate the risk and outcomes of second hematologic malignancies (SHMs) in a population-based cohort of patients with well-differentiated thyroid cancer (WDTC) treated or not with radioactive iodine (RAI). Methods Patients with WDTC were identified from SEER registries. Competing risk regression analysis was performed to calculate the risks of SHMs that occurred after WDTC treatment and outcomes after SHM development were assessed. Results Of 148,215 patients with WDTC, 53% received surgery alone and 47% received RAI. In total, 783 patients developed an SHM after a median interval of 6.5 years (interquartile range, 3.3 to 11.2 years) from WDTC diagnosis. In multivariable analysis, compared with those undergoing thyroidectomy alone, RAI treatment was associated with an increased early risk of developing acute myeloid leukemia (AML; hazard ratio, 1.79; 95% CI, 1.13 to 2.82; P = .01) and chronic myeloid leukemia (CML; hazard ratio, 3.44; 95% CI, 1.87 to 6.36; P < .001). This increased risk of AML and CML after RAI treatment was seen even in low-risk and intermediate-risk WDTC tumors. Occurrence of AML but not CML in patients with WDTC was associated with shorter median overall survival compared with matched controls (8.0 years v 31.0 years; P = .001). In addition, AML developing after RAI trended toward inferior survival compared with matched controls with de novo AML (median overall survival, 1.2 years v 2.9 years; P = .06). Conclusion Patients with WDTC treated with RAI had an increased early risk of developing AML and CML but no other hematologic malignancies. AML that arises after RAI treatment has a poor prognosis. RAI use in patients with WDTC should be limited to patients with high-risk disease features, and patients with WDTC treated with adjuvant RAI should be monitored for myeloid malignancies as part of cancer surveillance.
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In a retrospective review of the SEER registry (n=148,215), the risk for hematologic malignancies after postsurgery radioiodine treatment of well-differentiated thyroid cancer appears significantly higher than in patients managed with surgery alone (hazard ratio, 1.43; 95% CI, 1.20-1.69; P<0.001).
“In a retrospective review of the Surveillance, Epidemiology, and End Results Program (SEER) registry ( n 5 148,215), the risk for hematologic malignancies after postsurgery radioiodine treatment of well-differentiated thyroid cancer appears to be signi fi cantly higher than patients managed with surgery alone (hazard ratio, 1.43; 95% CI, 1.20 to 1.69; P , 0.001) ( 99 );”
From Normal-Tissue Tolerance to Radiopharmaceutical Therapies, the Knowns and the Unknowns (2021) · cites this paper as [99]
The absolute risk of hematologic malignancies after surgery plus radioiodine therapy appears quite low, approximately 0.54% within 10 years.
“however, the absolute risk appears quite low, approximately 0.54% within 10 y of surgery plus radioiodine therapy.”
From Normal-Tissue Tolerance to Radiopharmaceutical Therapies, the Knowns and the Unknowns (2021) · cites this paper as [99]
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Cites
Haugen, B. R., Alexander, E. K., Bible, K. C., Doherty, G. M., Mandel, S. J., Nikiforov, Y. E., Pacini, F., Randolph, G. W., Sawka, A. M., Schlumberger, M., et al. (2016) · Thyroid® · doi:10.1089/thy.2015.0020 · Cited by 16,535 · see citing works
Arber, D. A., Orazi, A., Hasserjian, R., Thiele, J., Borowitz, M. J., Le Beau, M. M., Bloomfield, C. D., Cazzola, M., & Vardiman, J. W. (2016) · Blood · doi:10.1182/blood-2016-03-643544 · Cited by 10,119 · see citing works
Trends in Thyroid Cancer Incidence and Mortality in the United States, 1974-2013
Lim, H., Devesa, S. S., Sosa, J. A., Check, D., & Kitahara, C. M. (2017) · JAMA · doi:10.1001/jama.2017.2719 · Cited by 2,159 · see citing works
Second primary malignancies in thyroid cancer patients
Rubino, C., de Vathaire, F., Dottorini, M. E., Hall, P. N., Schvartz, C., Couette, J. E., Dondon, M., Abbas, M., Langlois, C., & Schlumberger, M. J. (2003) · British Journal of Cancer · doi:10.1038/sj.bjc.6601319 · Cited by 651 · see citing works
Regression modeling of competing risk using R: an in depth guide for clinicians
Scrucca, L., Santucci, A., & Aversa, F. (2010) · Bone Marrow Transplantation · doi:10.1038/bmt.2009.359 · Cited by 459 · see citing works
How to obtain the confidence interval from a P value
Altman, D., & Bland, J. (2011) · British medical journal · doi:10.1136/bmj.d2090 · Cited by 450 · see citing works
The Incidence of Leukemia, Lymphoma and Multiple Myeloma among Atomic Bomb Survivors: 1950–2001
Hsu, W.-L., Preston, D. L., Soda, M., Sugiyama, H., Funamoto, S., Kodama, K., Kimura, A., Kamada, N., Dohy, H., Tomonaga, M., et al. (2013) · Radiation Research · doi:10.1667/rr2892.1 · Cited by 409 · see citing works
Brown, A. P., Chen, J., Hitchcock, Y. J., Szabó, A., Shrieve, D. C., & Tward, J. D. (2007) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2007-1154 · Cited by 384 · see citing works
Sawka, A. M., Thabane, L., Parlea, L., Ibrahim-zada, I., Tsang, R. W. C., Brierley, J. D., Straus, S. E., Ezzat, S., & Goldstein, D. P. (2009) · Thyroid · doi:10.1089/thy.2008.0392 · Cited by 352 · see citing works
Iyer, N. G., Morris, L. G. T., Tuttle, R. M., Shaha, A. R., & Ganly, I. (2011) · Cancer · doi:10.1002/cncr.26070 · Cited by 321 · see citing works
Second Primary Cancers in Thyroid Cancer Patients: A Multinational Record Linkage Study
Sandeep, T. C., Strachan, M. W. J., Reynolds, R. M., Brewster, D., Scélo, G., Pukkala, ., Hemminki, K., Anderson, A., Tracey, E. A., Friis, S., et al. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-2009 · Cited by 190 · see citing works
Use of Radioactive Iodine for Thyroid Cancer
Haymart, M. R. (2011) · JAMA · doi:10.1001/jama.2011.1139 · Cited by 187 · see citing works
Klein Hesselink, E. N., Klein Hesselink, M. S., de Bock, G. H., Gansevoort, R. T., Bakker, S. J. L., Vredeveld, E. J., van der Horst-Schrivers, A. N. A., van der Horst, I. C. C., Kamphuisen, P. W., Plukker, J. T. M., et al. (2013) · Journal of Clinical Oncology · doi:10.1200/jco.2013.49.1043 · Cited by 183 · see citing works
Second Primary Malignancy Risk in Thyroid Cancer Survivors: A Systematic Review and Meta-Analysis
Subramanian, S. L., Goldstein, D. P., Parlea, L., Thabane, L., Ezzat, S., Ibrahim-zada, I., Straus, S. E., Brierley, J. D., Tsang, R. W. C., Gafni, A., et al. (2007) · Thyroid · doi:10.1089/thy.2007.0171 · Cited by 154 · see citing works
Thyroid cancer and multiple primary tumors in the SEER cancer registries1
Ronckers, C. M., McCarron, P., & Ron, E. (2005) · International Journal of Cancer · doi:10.1002/ijc.21064 · Cited by 145 · see citing works
Teng, C., Hu, Y., Chen, S., et al. (2015) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djv314 · Cited by 104 · see citing works
Nixon, I. J., Ganly, I., Patel, S. G., Palmer, F. L., DiLorenzo, M. M., Grewal, R. K., Larson, S. M., Tuttle, R. M., Shaha, A., & Shah, J. P. (2013) · Thyroid · doi:10.1089/thy.2012.0307 · Cited by 92 · see citing works
Radivoyevitch, T., Sachs, R. K., Gale, R. P., Molenaar, R. J., Brenner, D. J., Hill, B. T., Kalaycio, M. E., Carraway, H. E., Mukherjee, S., Sekeres, M. A., et al. (2015) · Leukemia · doi:10.1038/leu.2015.258 · Cited by 89 · see citing works
Self-citationSecond primary malignancies following thyroid cancer: a population-based study in Taiwan
Lu, C.-H., Lee, K., Chen, P.-T., et al. (2013) · European Journal of Endocrinology · doi:10.1530/eje-13-0309 · Cited by 55 · see citing works
Acute Myeloid Leukemia Following Prolonged Iodine-131 Therapy for Metastatic Thyroid Carcinoma
Seidlin, S. M., Siegel, E. T., Yalow, A. A., et al. (1956) · Science · doi:10.1126/science.123.3201.800 · Cited by 49 · see citing works
Shimon, I., Kneller, A., & Olchovsky, D. (1995) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1995.tb02932.x · Cited by 40 · see citing works
Therapy-related myeloid neoplasms following treatment with radioiodine
Schroeder, T. A., Kuendgen, A., Käyser, S., Kröger, N. M., Braulke, F., Platzbecker, U., Klärner, V., Zohren, F., Haase, D. T., Stadler, M., et al. (2011) · Haematologica · doi:10.3324/haematol.2011.049114 · Cited by 38 · see citing works
Therapy-related myeloid neoplasms
Klimek, V. M., & Tray, N. (2016) · Current Opinion in Hematology · doi:10.1097/moh.0000000000000222 · Cited by 17 · see citing works
Therapy-related acute myeloid leukemia following radioactive iodine treatment for thyroid cancer
Oluwasanjo, A., Pathak, R., Ukaigwe, A. C., et al. (2015) · Cancer Causes & Control · doi:10.1007/s10552-015-0682-5 · Cited by 14 · see citing works
Acute leukemia arising after radioiodine treatment for thyroid cancer
Gilabert, M., & Prébet, T. (2012) · Haematologica · doi:10.3324/haematol.2012.067454 · Cited by 14 · see citing works
Roman, B. R., Feingold, J. H., Patel, S. G., Shaha, A. R., Shah, J. P., Tuttle, R. M., & Epstein, A. J. (2014) · Thyroid · doi:10.1089/thy.2014.0237 · Cited by 12 · see citing works
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Normal-Tissue Tolerance to Radiopharmaceutical Therapies, the Knowns and the Unknowns
Wahl, R. L., Sgouros, G., Iravani, A., Jacene, H., Pryma, D., Saboury, B., Capala, J., & Graves, S. A. (2021) · Journal of Nuclear Medicine · doi:10.2967/jnumed.121.262751 · Cited by 95 · see citing works
- Authors
- Molenaar, R. J., Sidana, S., Radivoyevitch, T., Advani, A. S., Gerds, A. T., Carraway, H. E., Angelini, D., Kalaycio, M., Nazha, A., Adelstein, D. J., Nasr, C., Maciejewski, J. P., Majhail, N. S., Sekeres, M. A., & Mukherjee, S.
- Affiliations
- Cleveland Clinic (US)
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2018-06-20
- Volume
- 36
- Issue
- 18
- Pages
- 1831-1839
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- PMC
- PMC8462524
- OpenAlex
- W2780504388
- Cited by
- 154
- References
- 26
- Citations by year
- 2026: 4 · 2025: 18 · 2024: 13 · 2023: 16 · 2022: 28 · 2021: 21 · 2020: 10 · 2019: 16 · 2018: 27 · 2016: 1
- FWCI
- 11.36
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of Clinical Oncology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R35HL135795)
- National Cancer Institute (K12CA076917, U10CA180853)
- Topics
- Health Sciences › Medicine › Epidemiology › Multiple and Secondary Primary Cancers
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- differentiated thyroid cancer, radioiodine therapy, second primary malignancy, hematologic malignancies, acute myeloid leukemia, chronic myeloid leukemia, thyroidectomy, overall survival, cancer surveillance, competing risk regression
- MeSH terms
- Adult, Female, Humans, Iodine Radioisotopes, Male, Middle Aged, Neoplasms, Radiation-Induced, Registries, Risk, Thyroid Neoplasms, Thyroidectomy, United States, Cohort Studies, SEER Program, Hematologic Neoplasms
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