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Evaluation of epidemiological factors in survival of patients with de novo myelodysplastic syndromes

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Abstract

Myelodysplastic syndromes (MDS) prognosis is currently based solely on clinical parameters. The identification of additional factors associated with MDS outcome could be used to further improve the current scoring system such as the International Prognostic Scoring System (IPSS). The present study evaluates the role of epidemiological markers as predictors of survival for 365 adult de novo MDS patients. Multivariable Cox regression analysis was used to estimate overall survival. Median follow-up time was 22 months. At the time of last follow-up, 271 patients (74.3 %) had died. For all MDS patients, medium–high lifetime occupational agrochemical exposure (HR 1.85, CI 1.19–2.89) remained as an independent predictor of MDS survival. Stratified analysis by gender showed that ≥25 pack-years smoked (HR 1.44, CI 1.001–2.09) and medium–high lifetime occupational agrochemical exposure (HR 1.84, CI 1.15–2.97) were independent predictors of MDS survival in men, but not in women. For MDS patients stratified by IPSS categories, ≥25 pack-years smoked (HR 1.75, CI 1.005–3.06) was an independent predictor for intermediate 1 IPSS risk group only, and medium–high lifetime occupational agrochemical exposure was associated with increased mortality (HR 4.36, CI 1.20–15.8) in the high IPSS risk group. Smoking and lifetime occupational agrochemical exposure may play a role in MDS survival. Incorporating relevant epidemiological markers with known clinical predictors of outcome may help physician stratify patients and customize treatment strategies to improve the outcome of MDS.

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References

  1. Greenberg PL, Young NS, Gattermann N (2002) Myelodysplastic syndromes. Hematology/the Education Program of the American Society of Hematology American Society of Hematology Education Program, pp 136–161

  2. Pedersen-Bjergaard J, Andersen MK, Christiansen DH, Nerlov C (2002) Genetic pathways in therapy-related myelodysplasia and acute myeloid leukemia. Blood 99(6):1909–1912

    Article  CAS  PubMed  Google Scholar 

  3. Cotran RS, Kumar V, Collins TR (1999) Pathological basis of disease, vol 6. WB Saunders Company, Philadelphia

    Google Scholar 

  4. Goldberg H, Lusk E, Moore J, Nowell PC, Besa EC (1990) Survey of exposure to genotoxic agents in primary myelodysplastic syndrome—correlation with chromosome patterns and data on patients without hematological disease. Cancer Res 50(21):6876–6881

    CAS  PubMed  Google Scholar 

  5. Mele A, Szklo M, Visani G, Stazi MA, Castelli G, Pasquini P, Mandelli F (1994) Hair dye use and other risk factors for leukemia and pre-leukemia: a case–control study. Italian leukemia study group. Am J Epidemiol 139(6):609–619

    CAS  PubMed  Google Scholar 

  6. Strom SS, Gu Y, Gruschkus SK, Pierce SA, Estey EH (2005) Risk factors of myelodysplastic syndromes: a case–control study. Leukemia 19(11):1912–1918. doi:10.1038/sj.leu.2403945

    Article  CAS  PubMed  Google Scholar 

  7. Breccia M, Finsinger P, Loglisci G, Santopietro M, Salaroli A, Serrao A, Latagliata R, Volpicelli P, Petrucci L, Nanni M, Alimena G (2012) Prognostic features of patients with myelodysplastic syndromes aged <50 years: update of a single-institution experience. Leuk Lymphoma 53(12):2439–2443. doi:10.3109/10428194.2012.698738

    Article  PubMed  Google Scholar 

  8. Rollison DE, Howlader N, Smith MT, Strom SS, Merritt WD, Ries LA, Edwards BK, List AF (2008) Epidemiology of myelodysplastic syndromes and chronic myeloproliferative disorders in the United States, 2001–2004, using data from the NAACCR and SEER programs. Blood 112(1):45–52. doi:10.1182/blood-2008-01-134858

    Article  CAS  PubMed  Google Scholar 

  9. Greenberg P, Cox C, LeBeau MM, Fenaux P, Morel P, Sanz G, Sanz M, Vallespi T, Hamblin T, Oscier D, Ohyashiki K, Toyama K, Aul C, Mufti G, Bennett J (1997) International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood 89(6):2079–2088

    CAS  PubMed  Google Scholar 

  10. Garcia-Manero G, Shan J, Faderl S, Cortes J, Ravandi F, Borthakur G, Wierda WG, Pierce S, Estey E, Liu J, Huang X, Kantarjian H (2008) A prognostic score for patients with lower risk myelodysplastic syndrome. Leukemia 22(3):538–543. doi:10.1038/sj.leu.2405070

    Article  CAS  PubMed  Google Scholar 

  11. Muller-Berndorff H, Haas PS, Kunzmann R, Schulte-Monting J, Lubbert M (2006) Comparison of five prognostic scoring systems, the French–American–British (FAB) and World Health Organization (WHO) classifications in patients with myelodysplastic syndromes: results of a single-center analysis. Ann Hematol 85(8):502–513. doi:10.1007/s00277-005-0030-z

    Article  CAS  PubMed  Google Scholar 

  12. Verburgh E, Achten R, Maes B, Hagemeijer A, Boogaerts M, De Wolf-Peeters C, Verhoef G (2003) Additional prognostic value of bone marrow histology in patients subclassified according to the International Prognostic Scoring System for myelodysplastic syndromes. J Clin Oncol 21(2):273–282

    Article  CAS  PubMed  Google Scholar 

  13. Belli C, Acevedo S, Bengio R, Arrossagaray G, Watman N, Rossi N, Garcia J, Flores G, Goldztein S, Larripa I (2002) Detection of risk groups in myelodysplastic syndromes. A multicenter study. Haematologica 87(1):9–16

    PubMed  Google Scholar 

  14. Greenberg PL, Tuechler H, Schanz J, Sanz G, Garcia-Manero G, Sole F, Bennett JM, Bowen D, Fenaux P, Dreyfus F, Kantarjian H, Kuendgen A, Levis A, Malcovati L, Cazzola M, Cermak J, Fonatsch C, Le Beau MM, Slovak ML, Krieger O, Luebbert M, Maciejewski J, Magalhaes SM, Miyazaki Y, Pfeilstocker M, Sekeres M, Sperr WR, Stauder R, Tauro S, Valent P, Vallespi T, van de Loosdrecht AA, Germing U, Haase D (2012) Revised international prognostic scoring system for myelodysplastic syndromes. Blood 120(12):2454–2465. doi:10.1182/blood-2012-03-420489

    Article  CAS  PubMed  Google Scholar 

  15. Dosemeci M, Cocco P, Gomez M, Stewart PA, Heineman EF (1994) Effects of three features of a job-exposure matrix on risk estimates. Epidemiology 5(1):124–127

    Article  CAS  PubMed  Google Scholar 

  16. Mauritzson N, Johansson B, Rylander L, Albin M, Stromberg U, Billstrom R, Ahlgren T, Mikoczy Z, Mitelman F, Hagmar L, Nilsson PG (2001) The prognostic impact of karyotypic subgroups in myelodysplastic syndromes is strongly modified by sex. Br J Haematol 113(2):347–356. doi:10.1046/j.1365-2141.2001.02750.x

    Article  CAS  PubMed  Google Scholar 

  17. Ma X, Wang R, Galili N, Mayne ST, Wang SA, Yu H, Raza A (2011) Cigarette smoking shortens the survival of patients with low-risk myelodysplastic syndromes. Cancer Causes Control 22(4):623–629. doi:10.1007/s10552-011-9735-6

    Article  PubMed Central  PubMed  Google Scholar 

  18. Komrokji R, Rollison DE, Al Ali NH et al. (2011) Tobacco use influence disease outcome and AML potential in myelodysplastic syndromes. In: 53rd ASH Annual Meeting and Exposition, San Diego Convention Center, December 10–13, 2011. American Society of Hematology, p 633. https://ash.confex.com/ash/2011/webprogram/Paper36908.html

  19. Smith CJ, Hansch C (2000) The relative toxicity of compounds in mainstream cigarette smoke condensate. Food Chem Toxicol 38(7):637–646

    Article  CAS  PubMed  Google Scholar 

  20. Sopori M (2002) Effects of cigarette smoke on the immune system. Nat Rev Immunol 2(5):372–377. doi:10.1038/nri803

    Article  CAS  PubMed  Google Scholar 

  21. Stampfli MR, Anderson GP (2009) How cigarette smoke skews immune responses to promote infection, lung disease and cancer. Nat Rev Immunol 9(5):377–384. doi:10.1038/nri2530

    Article  PubMed  Google Scholar 

  22. Dayyani F, Conley AP, Strom SS, Stevenson W, Cortes JE, Borthakur G, Faderl S, O’Brien S, Pierce S, Kantarjian H, Garcia-Manero G (2010) Cause of death in patients with lower-risk myelodysplastic syndrome. Cancer 116(9):2174–2179. doi:10.1002/cncr.24984

    PubMed Central  PubMed  Google Scholar 

  23. Naqvi K, Garcia-Manero G, Sardesai S, Oh J, Vigil CE, Pierce S, Lei X, Shan J, Kantarjian HM, Suarez-Almazor ME (2011) Association of comorbidities with overall survival in myelodysplastic syndrome: development of a prognostic model. J Clin Oncol 29(16):2240–2246. doi:10.1200/JCO.2010.31.3353

    Article  PubMed Central  PubMed  Google Scholar 

  24. Rigolin GM, Porta MD, Bugli AM, Castagnari B, Mauro E, Bragotti LZ, Ciccone M, Cuneo A, Castoldi G (2004) Flow cytometric detection of accelerated telomere shortening in myelodysplastic syndromes: correlations with aetiological and clinical-biological findings. Eur J Haematol 73(5):351–358. doi:10.1111/j.1600-0609.2004.00305.x

    Article  PubMed  Google Scholar 

  25. Cawthon RM, Smith KR, O’Brien E, Sivatchenko A, Kerber RA (2003) Association between telomere length in blood and mortality in people aged 60 years or older. Lancet 361(9355):393–395. doi:10.1016/S0140-6736(03)12384-7

    Article  CAS  PubMed  Google Scholar 

  26. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348(17):1625–1638. doi:10.1056/NEJMoa021423

    Article  PubMed  Google Scholar 

  27. Castillo JJ, Reagan JL, Ingham RR, Furman M, Dalia S, Merhi B, Nemr S, Zarrabi A, Mitri J (2012) Obesity but not overweight increases the incidence and mortality of leukemia in adults: a meta-analysis of prospective cohort studies. Leuk Res 36(7):868–875. doi:10.1016/j.leukres.2011.12.020

    Article  PubMed  Google Scholar 

  28. Medeiros BC, Othus M, Estey EH, Fang M, Appelbaum FR (2012) Impact of body-mass index on the outcome of adult patients with acute myeloid leukemia. Haematologica 97(9):1401–1404. doi:10.3324/haematol.2011.056390

    Article  PubMed Central  PubMed  Google Scholar 

  29. Lee HJ, Licht AS, Hyland AJ, Ford LA, Sait SN, Block AW, Barcos M, Baer MR, Wang ES, Wetzler M (2012) Is obesity a prognostic factor for acute myeloid leukemia outcome? Ann Hematol 91(3):359–365. doi:10.1007/s00277-011-1319-8

    Article  PubMed  Google Scholar 

  30. van Kruijsdijk RC, van der Wall E, Visseren FL (2009) Obesity and cancer: the role of dysfunctional adipose tissue. Cancer Epidemiol Biomarkers Prev 18(10):2569–2578. doi:10.1158/1055-9965.EPI-09-0372

    Article  PubMed  Google Scholar 

  31. Gregor MF, Hotamisligil GS (2011) Inflammatory mechanisms in obesity. Annu Rev Immunol 29:415–445. doi:10.1146/annurev-immunol-031210-101322

    Article  CAS  PubMed  Google Scholar 

  32. Nieman DC, Henson DA, Nehlsen-Cannarella SL, Ekkens M, Utter AC, Butterworth DE, Fagoaga OR (1999) Influence of obesity on immune function. J Am Diet Assoc 99(3):294–299. doi:10.1016/S0002-8223(99)00077-2

    Article  CAS  PubMed  Google Scholar 

  33. Parekh N, Okada T, Lu-Yao GL (2009) Obesity, insulin resistance, and cancer prognosis: implications for practice for providing care among cancer survivors. J Am Diet Assoc 109(8):1346–1353. doi:10.1016/j.jada.2009.05.001

    Article  PubMed Central  PubMed  Google Scholar 

  34. van der Leeuw J, Wassink AM, van der Graaf Y, Westerveld HE, Visseren FL, Second Manifestations of ADSG (2013) Age-related differences in abdominal fat distribution in premenopausal and postmenopausal women with cardiovascular disease. Menopause 20(4):409–417. doi:10.1097/gme.0b013e31827212a5

    PubMed  Google Scholar 

  35. Wang YC, McPherson K, Marsh T, Gortmaker SL, Brown M (2011) Health and economic burden of the projected obesity trends in the USA and the UK. Lancet 378(9793):815–825. doi:10.1016/S0140-6736(11)60814-3

    Article  PubMed  Google Scholar 

  36. Teschke K, Olshan AF, Daniels JL, De Roos AJ, Parks CG, Schulz M, Vaughan TL (2002) Occupational exposure assessment in case–control studies: opportunities for improvement. Occup Environ Med 59(9):575–593 (discussion 594)

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Aul C, Giagounidis A, Germing U (2001) Epidemiological features of myelodysplastic syndromes: results from regional cancer surveys and hospital-based statistics. Int J Hematol 73(4):405–410

    Article  CAS  PubMed  Google Scholar 

  38. Phellan J, Kouides PA, Bennett JM (2002) Myelodysplastic syndromes: historical aspects and classification  In: Bennett J (ed) The myelodysplastic syndromes pathobiology and clinical management. Marcel Dekker Inc., New York

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Acknowledgments

This work was supported by National Cancer Institute (NCI) Grants CA100632 and CA115180 and NIEHS ES007784. We are grateful to Suraj Sander whose thesis for Master in Public Health has inspired this project. Finally, we give special thanks to our data collection team and our participants.

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    Kplola Y. Elhor Gbito

  2. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    Guillermo Garcia-Manero

  3. Department of Epidemiology, The University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Unit 1340, Houston, TX, 77030, USA

    Sara S. Strom

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  1. Kplola Y. Elhor Gbito
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Correspondence to Sara S. Strom.

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Elhor Gbito, K.Y., Garcia-Manero, G. & Strom, S.S. Evaluation of epidemiological factors in survival of patients with de novo myelodysplastic syndromes. Cancer Causes Control 25, 425–435 (2014). https://doi.org/10.1007/s10552-014-0345-y

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  • DOI: https://doi.org/10.1007/s10552-014-0345-y

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