Examining the Risk of Cardiovascular Disease–Related Mortality in Patients With and MDS/CMML

Patients with chronic myelomonocytic leukemia (CMML) and myelodysplastic syndromes (MDS) have a higher risk of cardiovascular disease (CVD)–related mortality and cerebrovascular accident (CVA)–related mortality, according to results presented at the 2017 ASH Annual Meeting.

Lead author Remco J. Molenaar, MD, PhD, from the Taussig Cancer Institute at Cleveland Clinic in Ohio, told ASH Clinical News, “This is the first study to investigate rates and risks of CVD–related deaths in CMML and MDS, two types of myeloid neoplasms (MPN) frequently affected by TET2 mutations, at the population level.” Because mortality risk was particularly high in the first year after diagnosis, he added, these patients likely already had underlying CVD.

Researchers reviewed Surveillance Epidemiology and End Results (SEER) registries to gather survival and cause-of-death data on patients with CMML (n=4,699), MDS (n=38,304), breast cancer (n=1,053,780), or prostate cancer (n=1,082,390). The latter two cancers were selected as controls because they are not associated with mutations typically seen with myeloid malignancies and that have been established as risk factors for CVD.

“During the full duration of follow-up, roughly 10 percent of these patients died from CVD or CVA,” Dr. Molenaar said (see TABLE). Compared with mortality rates in the general population, calculated using data from the Centers for Disease Control’s Wonder dataset, “the risk of having CVD–related mortality is about five or six times higher in a patient with MDS, CMML, or MDS/MPN-unclassifiable” Dr. Molenaar said.

However, the risks among patients with breast or prostate cancer decreased during the 10 years after diagnosis. Relative risks (RRs) for CVD– and CVA–related mortality (adjusted for age, sex, and year) were:

  • CMML: RR=2.98 (95% CI 2.69-3.29; p=0.6×10-90)
  • MDS: RR=2.61 (95% CI 2.53-2.70; p<1×10-100)
  • breast cancer: RR=0.99 (0.98-1.00; p=0.03)
  • prostate cancer: RR=0.90 (95% CI 0.90-0.91; p<1×10-100)

Although the risks for CVD– and CVA–related mortality were highest during the first year after cancer diagnosis for patients with CMML and MDS, Dr. Molenaar noted, it remained elevated at two to three times the adjusted risk relative to the general population through 10 years after cancer diagnosis.

This evidence supports the conclusions of prospective case-control studies and the need for screening patients with newly diagnosed CMML and MDS for CVD, the authors concluded.

“When a patient is diagnosed, [they  should undergo] a cardiovascular work-up to see if anything can be managed,” Dr. Molenaar said. “Our data suggest that those patients can benefit from aggressive cardiovascular risk factor management.”

Though this was a large, population-level analysis, he added, it was limited by the lack of “granular” data captured in the SEER database. Future analyses are evaluating smaller European registries that capture these data and will hopefully shed more light on the specific types of fatal cardiovascular events, he added.

The authors report no relevant conflicts of interest.

Reference

Molenaar RJ, Radivoyevitch T, Sekeres MA, et al. High rates of atherosclerotic disease-related mortality in myelodysplastic syndromes and chronic myelomonocytic leukemia patients associated with TET2-mutations. Abstract #421. Presented at the 2017 American Society of Hematology Annual Meeting, December 10, 2017; Atlanta, GA.

References

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