{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:54:01Z","timestamp":1788501241836,"version":"build-2803163510"},"reference-count":61,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,5,28]],"date-time":"2021-05-28T00:00:00Z","timestamp":1622160000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Haematology"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The aim of this study was to determine risk factors for development of acute myeloid leukemia\/myelodysplastic syndromes (AML\/MDS) in patients with multiple myeloma (MM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified all patients diagnosed with MM in Sweden from January 1st, 1958 to December 31, 2011. A total of 26\u00a0627 patients were diagnosed with MM with during the study period. Of these, 124 patients (0.5%) developed subsequent AML\/MDS. For each patient with MM and a subsequent AML\/MDS diagnosis, we randomly selected a matched (age, sex, and date of MM diagnosis) MM patient without a subsequent second malignancy diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cumulative melphalan exposure was significantly higher (OR\u00a0=\u00a02.8, 95% CI 1.7\u20105.2;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001) among cases (median 988\u00a0mg; IQR 644\u20101640) compared with controls (median 578\u00a0mg; IQR 360\u2010967). Median time to AML\/MDS development was 3.8\u00a0years (IQR 2.8\u20105.8). Risk of AML\/MDS was not statistically altered by M protein isotype, anemia, renal failure, hypercalcemia, lytic bone lesions, or radiation therapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this nationwide population\u2010based study, we show that increased cumulative doses of alkylating therapy with melphalan increases the subsequent risk of developing AML\/MDS in patients with MM. Given improved survival in MM patients over the last decade future studies will be important to better define long\u2010term risks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ejh.13650","type":"journal-article","created":{"date-parts":[[2021,5,9]],"date-time":"2021-05-09T06:30:15Z","timestamp":1620541815000},"page":"275-282","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Cumulative exposure to melphalan chemotherapy and subsequent risk of developing acute myeloid leukemia and myelodysplastic syndromes in patients with multiple myeloma"],"prefix":"10.1111","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8958-6022","authenticated-orcid":false,"given":"Gudbjorg","family":"Jonsdottir","sequence":"first","affiliation":[{"name":"Faculty of Medicine University of Iceland  Reykjavik Iceland"},{"name":"Department of Hematology, Oncology, Blood and Marrow Transplantation University of Iowa 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