Registry studies on myelodysplastic syndrome and secondary acute myeloid leukemia

Abstract

The aims were (I) to describe a European lower risk MDS population and the use of erythropoietin stimulation agents (ESA), (II) to describe the AML population in Sweden 1997-2006 with emphasis on secondary AML (s-AML) and therapy-related AML (t-AML), (III) to investigate the use and effect of allogeneic hematopoietic stem cell transplantation (HSCT) in the AML population in Sweden 1997-2013, and (IV) to merge patients from the Swedish AML Registry 2009-14 with patients from the Swedish MDS Registry 2009-14 in order to describe the patients with s-AML after MDS from time of MDS diagnosis and AML diagnosis. Patients, methods and results: (I) ESA treatment were given to 45.6% patients with lower risk MDS, median duration 27.5 months. A propensity model, comparing ESA-treated and untreated was used. Median time to first post-ESA treatment transfusion was 6.1 months in patients transfused before ESA treatment compared to 23.3 months in non-transfused patients (p<0,0001), showing that ESAs can significantly delay the onset of a regular transfusion need in patients with lower-risk MDS. (II) Of 3,363 AML patients with induction therapy, 73.6% were de novo AML, 18.7% had antecedent hematological disease (AHD-AML), and 7.7% had t-AML. S-AML-patients were older compared to de novo AML and had higher cytogenetic risk scores. Multivariate analysis showed that AHD-AML and t-AML were independent risk factors for inferior survival in the younger age groups. (III) Of 3337 intensively treated patients, 21% underwent HSCT at any stage of the disease. Five-year survival without and with allogeneic HSCT were 0% vs 50% for MPN-AML, 3% vs 39% for MDS-AML, 8% vs. 48% for t-AML and 24% vs. 57% for de novo AML-patients. Presence of any chronic graft versus host disease (cGvHD) compared to no cGvHD and a GvHD grade 1 or lower was significantly associated to better survival in a multivariable analysis. Allogeneic HSC is the only option for cure in S-AML. (IV)We found 257 patients with sufficient information from both AML and MDS registries for further examination. 72.2% had high risk cytogenetics and 66.8%, had performance status 0-1 at AML diagnosis. Median time from MDS diagnosis to AML diagnosis was 10.8 months. Median survival time for S-AML was 4.93 months. Allogeneic HSCT improves survival significantly in the younger age groups.