Abstract
Myelodysplastic syndromes (MDS) are a group of hematological malignancies with poor survival. Although previous studies have identified the prognostic role of multiple demographic and clinical characteristics, the potential role of lifestyle factors has not been evaluated. In this study, we conducted an extensive assessment of the predictors of MDS survival, with a special focus on lifestyle factors. A total of 616 patients (median survival = 4.1 years) were included in the analysis, and multivariate Cox proportional hazard models were utilized to estimate hazard ratios. Compared with non-smokers, MDS patients who smoked at the initial clinical encounter had a significantly increased risk of death [hazard ratio (HR) = 1.46, 95% confidence intervals (CI): 1.07–2.00]. The elevated risk was restricted to men (HR = 1.76, 95% CI: 1.21–2.56) and not observed among women (HR = 0.98, 95% CI: 0.51–1.85). When patients were stratified by the IPSS categorization, a near three fold increased risk of death was associated with smoking among patients with low-risk MDS (HR = 2.83, 95% CI: 1.48–5.39), whereas smoking did not appear to influence the survival of patients with intermediate- or high-risk MDS. This study was the first to identify smoking as a significant and independent predictor of MDS survival, particularly among low-risk patients.
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Corey SJ, Minden MD, Barber DL, Kantarjian H, Wang JC, Schimmer AD (2007) Myelodysplastic syndromes: the complexity of stem-cell diseases. Nat Rev Cancer 7:118–129
Ma X, Does M, Raza A, Mayne ST (2007) Myelodysplastic syndromes: incidence and survival in the United States. Cancer 109:1536–1542
Greenberg P, Cox C, LeBeau MM et al (1997) International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood 89:2079–2088
Bennett J (2002) The myelodysplastic syndromes: pathobiology and clinical management. In: Cheson B (ed) Basic and clinical oncology, vol 27. Marcel Dekker, New York
Wang R, Gross CP, Halene S, Ma X (2009) Neighborhood socioeconomic status influences the survival of elderly patients with myelodysplastic syndromes in the United States. Cancer Causes Control 20:1369–1376
Pogoda JM, Preston-Martin S, Nichols PW, Ross RK (2002) Smoking and risk of acute myeloid leukemia: results from a Los Angeles County case-control study. Am J Epidemiol 155:546–553
Fernberg P, Odenbro A, Bellocco R et al (2007) Tobacco use, body mass index, and the risk of leukemia and multiple myeloma: a nationwide cohort study in Sweden. Cancer Res 67:5983–5986
Kasim K, Levallois P, Abdous B, Auger P, Johnson KC (2005) Lifestyle factors and the risk of adult leukemia in Canada. Cancer Causes Control 16:489–500
Chelghoum Y, Danaila C, Belhabri A et al (2002) Influence of cigarette smoking on the presentation and course of acute myeloid leukemia. Ann Oncol 13:1621–1627
Varadarajan R, Licht A, Hyland AJ, et al. (2009) Smoking adversely affects survival in acute myeloid leukemia patients. ASH Annu Meet Abstr 114:979
International Standing Committee on Human Cytogenetic Nomenclature, Mitelman F (1995) ISCN 1995: an international system for human cytogenetic nomenclature (1995): recommendations of the international standing committee on human cytogenetic nomenclature, Memphis, Tennessee, USA, 9–13 Oct 1994. Karger, Basel
Bennett JM, Catovsky D, Daniel MT et al (1982) Proposals for the classification of the myelodysplastic syndromes. Br J Haematol 51:189–199
Harris NL, Jaffe ES, Diebold J et al (1999) The World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues. Report of the clinical advisory committee meeting, airlie house, Virginia, November, 1997. Ann Oncol 10:1419–1432
Vardiman JW, Harris NL, Brunning RD (2002) The world health organization (WHO) classification of the myeloid neoplasms. Blood 100:2292–2302
Thorne SL, Malarcher A, Maurice E, Caraballo R (2009) Cigarette smoking among adults—United States, 2007. JAMA 301:373–375
Bjork J, Albin M, Mauritzson N, Stromberg U, Johansson B, Hagmar L (2000) Smoking and myelodysplastic syndromes. Epidemiology 11:285–291
Bjork J, Johansson B, Broberg K, Albin M (2009) Smoking as a risk factor for myelodysplastic syndromes and acute myeloid leukemia and its relation to cytogenetic findings: a case-control study. Leuk Res 33:788–791
Mauritzson N, Johansson B, Rylander L et al (2001) The prognostic impact of karyotypic subgroups in myelodysplastic syndromes is strongly modified by sex. Br J Haematol 113:347–356
United States (2004) Public health service. Office of the surgeon general. National center for chronic disease prevention and health promotion (U.S.). The health consequences of smoking a report of the Surgeon General. [Atlanta, Ga.]: U.S. Public Health Service, National Center for Chronic Disease Prevention and Health Promotion
World health organization (2004) IARC. International agency for research on cancer (2002: Lyon). Tobacco smoke and involuntary smoking: views and expert opinions of an IARC working group on the evaluation of carcinogenic risks to humans, which met in Lyon, 11–18 June 2002. IARC, Lyon
Holt PG (1987) Immune and inflammatory function in cigarette smokers. Thorax 42:241–249
Sopori M (2002) Effects of cigarette smoke on the immune system. Nat Rev Immunol 2:372–377
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This work was supported by a grant from the National Cancer Institute (K07 CA119108).
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Ma, X., Wang, R., Galili, N. et al. Cigarette smoking shortens the survival of patients with low-risk myelodysplastic syndromes. Cancer Causes Control 22, 623–629 (2011). https://doi.org/10.1007/s10552-011-9735-6
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DOI: https://doi.org/10.1007/s10552-011-9735-6