Autoimmune disease status could be associated with survival outcomes in patients with myelodysplastic syndromes (MDS), a recent study suggests.
Diego Andres Adrianzen-Herrera, MD, of the University of Vermont, and colleagues conducted the study because “studies comparing outcomes in MDS patients with and without autoimmune disease show discordant results.”
The researchers used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to conduct a population analysis to “define the impact of autoimmunity on MDS outcomes.”
They evaluated 15,277 patients with MDS and used claim algorithms to identify autoimmune disease, demographic characteristics, comorbidity scores, MDS histology, transfusion burden, treatment with hypomethylating agents and hematopoietic stem cell transplant. The researchers used Cox regression models to estimate the impact on survival and competing-risk regression models to define the effect on leukemic transformation.
Dr. Adrianzen-Herrera and colleagues found that 16% of the patients analyzed had pre-existing autoimmune disease.
“The epidemiologic profile was distinctive in cases with pre-existing autoimmunity, who were younger, predominantly female, and had higher transfusion burden without difference in MDS histologic distribution,” they wrote.
Autoimmune disease was associated with 11% decreased risk of death (hazard ratio [HR], 0.89; 95% CI, 0.85-0.94; P<.001). However, the effect on risk of leukemic transformation “differed based on MDS histology,” according to the study’s authors. Autoimmunity was associated with a 1.9-fold increased risk of leukemia in patients with low-risk MDS (HR, 1.87; 95% CI, 1.17-2.99; P=.008). The researchers reported there was no significant effect of autoimmunity on leukemic transformation risk in other groups of patients.
“These results suggest that autoimmune disease affects survival in MDS and is associated with decreased mortality,” Dr. Adrianzen-Herrera and colleagues concluded. “The survival effect was evident in low-risk histologies, despite higher risk of progression to leukemia. This could represent inflammation-driven hematopoiesis simultaneously favoring less aggressive phenotypes and clonal expansion, which warrants further investigation.”
Reference
Adrianzen-Herrera DA, Sparks AD, Singh R, et al. Impact of preexisting autoimmune disease on myelodysplastic syndromes outcomes: A population analysis. Blood Adv. 2023. doi:10.1182/bloodadvances.2023011050