Outcomes of Patients With Therapy-Related MDS After Chemoimmunotherapy for Chronic Lymphocytic Leukemia Compared With Patients With De Novo MDS: A Single-Institution Experience.

Abstract

BACKGROUND:

Patients with chronic lymphocytic leukemia (CLL) treated with chemoimmunotherapy are at increased risk of developing therapy-related (t-) myelodysplastic syndrome (MDS). It is unclear whether antecedent CLL adds prognostic value to the revised International Prognostic Scoring System (IPSS-R) for MDS. We performed a retrospective analysis to evaluate the significance of a previous CLL diagnosis as an independent adverse prognostic factor.

PATIENTS AND METHODS:

We identified 18 consecutive patients with t-MDS, previously treated for CLL (CLL-MDS) from 2002 to 2016. For each CLL-MDS patient, we identified 2 control patients with de novo MDS matched for age (≤ 65 or > 65 years), IPSS-R (≤ 3 or > 3), and year of MDS diagnosis (before or after 2008). Multivariable models were developed to test for independent predictors of progression to acute myeloid leukemia (AML) and overall survival (OS).

RESULTS:

Median time from CLL to MDS diagnosis was 58.8 months (range, 12-280 months) and median number of treatment lines for CLL was 1 (range, 1-5), including alkylating agents in 15 patients (83%) and fludarabine, cyclophosphamide, rituximab in 12 patients (67%). Hypomethylating agents were administered in 13 (72%) of CLL-MDS patients and 33 (91%) of de novo MDS patients. After a median follow-up of 19.2 months, OS was not different between CLL-MDS and matched de novo MDS patients. CLL-MDS patients with IPSS-R score ≤ 3 had better OS compared with those with IPSS-R score > 3. In multivariate analysis, there was no significant independent association between history of CLL OS or progression to AML.

CONCLUSION:

History of CLL did not independently affect OS in t-MDS patients beyond IPSS-R score.

• Authors: Jason P Cooper, Sirin Khajaviyan, Stephen D Smith, David G Maloney, Andrei R Shustov, Edus H Warren, Lorinda A Soma, Ryan C Lynch, Chaitra Ujjani, Brian Till, Anna B Halpern, Ajay K Gopal, H Joachim Deeg, Bart L Scott, Mazyar Shadman
• Journal: Clinical lymphoma, myeloma & leukemia (Clin Lymphoma Myeloma Leuk) Vol. 19 Issue 6 Pg. 390-395 (06 2019) ISSN: 2152-2669 [Electronic] United States
• PMID: 30948330 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Combined Modality Therapy (adverse effects, methods)
• Female
• Humans
• Leukemia, Lymphocytic, Chronic, B-Cell (complications, diagnosis, mortality, therapy)
• Male
• Middle Aged
• Myelodysplastic Syndromes (diagnosis, etiology)
• Prognosis
• Retrospective Studies
• Treatment Outcome