A long-term study shows increasing rates of therapy-related AML as cancer survival improves, pushing clinical laboratories to expand genomic testing, enhance surveillance, and prepare for more complex secondary malignancies.
A new population-based study published in CANCER, a journal of the American Cancer Society, signals a growing diagnostic and surveillance challenge that clinical laboratories should take note of. Rates of therapy-related acute myeloid leukemia (tAML), a secondary blood cancer linked to prior chemotherapy and radiation exposure, are rising.
Researchers analyzing data from the Osaka Cancer Registry found that tAML incidence increased steadily between 1990 and 2020. Among nearly 10,000 AML cases, 6.5% were therapy-related, with incidence rising from 0.13 to 0.36 per 100,000 people. The proportion of tAML within total AML cases nearly doubled over the study period, reflecting a shifting disease burden tied to improved cancer survival.
(Photo credit: Phlebotomy Tech)
“The study provides an important step towards better understanding how the nature of tAML is changing with the increasing number of cancer survivors,” said lead author Kenji Kishimoto, MD, PhD, of the Osaka International Cancer Institute.
Rising Secondary Leukemia Demands Advanced Lab Testing
For clinical laboratories, the findings underscore the downstream impact of modern oncology treatments. As more patients survive primary cancers, labs are increasingly likely to encounter complex secondary malignancies requiring advanced hematologic testing, molecular profiling, and longitudinal monitoring. tAML, in particular, is associated with prior DNA damage from cytotoxic therapies, often presenting with aggressive clinical features and distinct genetic signatures.
The study also highlights changing patterns in primary cancers preceding tAML. While prior blood cancers remained the most common precursor, cases following breast cancer treatment rose notably over time, suggesting evolving risks tied to treatment regimens and survivorship trends. Colorectal and gastric cancers were also represented, though gastric cancer–associated cases declined.
For lab professionals, this trend reinforces the need to adapt testing strategies, expand genomic capabilities, and collaborate closely with oncology teams as therapy-related malignancies become a more visible component of routine diagnostic workflows.
This article was created with the assistance of Generative AI and has undergone editorial review before publishing.
—Janette Wider
