Therapy-Related Leukemia

Advani, Suresh H.; Doval, Divya; Gopal, R; Nair, C. N.; Kutty, P. M.

doi:10.1159/000225741

Cited by 22 publications

(1 citation statement)

References 14 publications

(17 reference statements)

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“…According to a study on the global burden of cancer in 2015, the estimated number of new cases of leukemia was 606,000 and 353,000 deaths were related to leukemia, ranking it as eighth for all cancer incidences and ninth for all cancer deaths, respectively (1). Risk factors include some genetic syndromes, ionizing radiation, some environmental or occupational exposures and medications (2,3). Diabetes patients may also suffer from a significantly higher risk of leukemia.…”

Section: Introductionmentioning

confidence: 99%

Metformin Use and Leukemia Risk in Patients With Type 2 Diabetes Mellitus

Tseng

2020

Front. Endocrinol.

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Background: The effect of metformin on leukemia risk remains unknown. Methods: The Taiwan's National Health Insurance database was used to enroll 610,089 newly diagnosed type 2 diabetes patients on at least 2 anti-diabetic prescriptions during 1999-2009. We followed-up these patients until 31 December 2011, in order to determine the incidence of leukemia. We used Cox regression model (incorporated with the inverse probability of treatment-weighting using propensity scores) to estimate hazard ratios in both intention-to-treat and per-protocol analyses. Results: We enrolled 414,783 metformin initiators and 195,306 non-metformin initiators. Among them, 598 and 372 patients developed new-onset leukemia after a median followup period of 5.08 years and 6.79 years, respectively. The respective incidence rates were 26.52 and 28.40 per 100,000 person-years. The hazard ratio for metformin initiators versus non-metformin initiators was 0.943 (95% confidence interval 0.828-1.074) in the intention-to-treat analysis and 0.852 (95% confidence interval 0.705-1.031) in the perprotocol analysis. Sensitivity analyses after excluding patients using the exclusion criteria (a follow-up duration < 24 and < 36 months, respectively, patients with incretin-based therapies during follow-up, and patients enrolled during 2 different periods of 1999-2003 and 2004-2009) consistently showed a neutral effect. However, metformin initiators had a significantly higher risk of leukemia in the per-protocol analyses when censoring patients at a time without regular follow-up. Conclusion: Metformin use has an overall neutral effect on leukemia but we cannot exclude a significantly higher risk in patients who persistently use the drug.

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Section: Introductionmentioning

confidence: 99%