Lower Progression Risk from MDS to AML Found in Patients With Autoimmune Disease

Research considers the importance of immunity in regulating the transformation from myelodysplastic syndrome to acute myeloid leukemia.

On February 13, 2016, researchers at the Department of Malignant Hematology at the H. Lee Moffitt Cancer Center Research Institute in Tampa, Florida, working in concert with researchers in the United Kingdom, published a study in the American Journal of Hematology suggesting an important role of immunity in protecting patients with myelodysplastic syndrome (MDS) from transformation to acute myeloid leukemia (AML).

In a study of 1408 patients with MDS, more than 28% had autoimmune disease. Of the autoimmune diseases present in the sample, hypothyroidism was the most common type, accounting for more than one-third (44%) of patients (n = 171). Among patients with myelodysplastic syndrome, several other autoimmune diseases were present, albeit with lower frequency.

Researchers reported autoimmune diseases occurring with a prevalence greater than or equal to 5% in the sample, including idiopathic purpurea in 12% of patients, rheumatoid arthritis in 10% of patients, and psoriasis in 7% of patients.

Autoimmune disease occurred more often in patients with certain specific subtypes of MDS. The median survival was 5 years, or 60 months (95% confidence interval: 50 months to 70 months) in patients with autoimmune disease versus 45 months (95% confidence interval: 40 months to 49 months) for those without autoimmune disease (P = .006).

In addition, in patients with MDS and autoimmune disease, transformation from MDS to AML was significantly less likely than in MDS patients without autoimmune disease. A total of 23% of patients with MDS and auto immune disease experienced transformation to AML versus 30% of patients with MDS who did not have autoimmune diseases. This was a statistically significant finding (P = .011).

In this study, researchers found a significant association between presence of autoimmune disease in patients with MDS and longer overall survival. Although this was a small difference in terms of magnitude, it shows the importance of immunity in regulating the transformation from MDS to acute myeloid leukemia, and may have important implications for the development of new therapeutic options.

Reference

Komrokji RS, Kulasekararaj A, Al Ali NH, et al. Autoimmune Diseases and Myelodysplastic Syndromes. Am J Hematol. 2016.