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Garnier R. [Environmental and occupational risk factors for myelodysplastic syndrome]. Bull Cancer 2023; 110:1116-1128. [PMID: 37419729 DOI: 10.1016/j.bulcan.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/03/2023] [Indexed: 07/09/2023]
Abstract
Chemotherapy and radiotherapy for a previous cancer can lead to subsequent myelodysplastic syndrome (MDS). However, these therapy-related cases are hypothesized to explain only 5 % of diagnosed MDS cases. Environmental or occupational exposure to chemicals or radiations has also been reported to be associated with higher risk of MDS. The present review analyses those studies evaluating the association of MDS with environmental or occupational risk factors. There is sufficient evidence that environmental or occupational exposure to ionizing radiation or benzene can cause MDS. Tobacco smoking is also a sufficiently documented riskfactor for MDS. A positive association has been reported between exposure to pesticides and MDS. However, there is only limited evidence that this association could be causal.
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Affiliation(s)
- Robert Garnier
- AP-HP, Hôpitaux universitaires Lariboisière-Fernand-Widal-Saint-Louis, Centre antipoison de Paris, FedTox, Paris, France.
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Liu Z, Xu X, Ding K, Fu R. Quality of life considerations and management in patients with myelodysplastic syndrome. Expert Rev Hematol 2023; 16:849-860. [PMID: 37819160 DOI: 10.1080/17474086.2023.2268837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION This study aimed to identify the factors affecting the quality of life (QOL) and functional status of patients with MDS. AREAS COVERED We reviewed the literature published in PUBMED over the past 30 years and searched for keywords such as 'quality of life' and 'myelodysplastic syndromes'. By observing the influence of their symptoms, the possibility of improving patients' QOL was considered by improving these related factors. Concurrently, the effects of related clinical treatments based on the unique disease characteristics of MDS on the patients' QOL were examined, and lifestyle factors were considered in clinical practice, providing an important path to improve the QOL and functional status of patients with MDS. EXPERT OPINION This review summarized several areas that can improve the quality of survival of MDS patients and discusses them in depth. Although the clinical benefits may be minimal, we still hope to improve patients' daily life outcomes and enhance their quality of life at minimal cost. Also, we hope more researchers will focus on this area in the future to find more factors that may exist to supplement the limitations of these understanding and thinking, and to provide assistance in clinical work.
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Affiliation(s)
- Zhaoyun Liu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xintong Xu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Kai Ding
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Rong Fu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
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3
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Shimomura Y, Sobue T, Zha L, Kitamura T, Iwasaki M, Inoue M, Yamaji T, Tsugane S, Sawada N. Association between meat, fish, and fatty acid intake and incidence of acute myeloid leukemia and myelodysplastic syndrome: the Japan Public Health Center-based Prospective Study. Environ Health Prev Med 2023; 28:19. [PMID: 36878605 PMCID: PMC10025862 DOI: 10.1265/ehpm.22-00233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/08/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The association between meat, fish, or fatty acid intake and acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) has been investigated in a few studies, and the results were inconsistent. In addition, most studies are mainly based on the United States and European countries, in which the dietary patterns differ from that in Asia. Therefore, the risk of AML/MDS from meat, fish, or fatty acid intake in Asia requires further exploration. The aim of this study was to investigate the association between AML/MDS incidence and meat, fish, or fatty acid intake using the Japan Public Health Center-based prospective study. METHODS The present study included 93,366 participants who were eligible for analysis and followed up from the 5-year survey date until December 2012. We estimated the impact of their intake on AML/MDS incidence using a Cox proportional hazards model. RESULTS The study participants were followed up for 1,345,002 person-years. During the follow-up period, we identified 67 AML and 49 MDS cases. An increased intake of processed red meat was significantly associated with the incidence of AML/MDS, with a hazard ratio of 1.63 (95% confidence interval, 1.03-2.57) for the highest versus lowest tertile and a Ptrend of 0.04. Meanwhile, the intake of other foods and fatty acids was not associated with AML/MDS. CONCLUSION In this Japanese population, processed red meat was associated with an increased incidence of AML/MDS.
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Affiliation(s)
- Yoshimitsu Shimomura
- Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
- Department of Hematology, Kobe City Hospital Organization Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tomotaka Sobue
- Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Ling Zha
- Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tetsuhisa Kitamura
- Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Motoki Iwasaki
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Manami Inoue
- Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Taiki Yamaji
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
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Abstract
Myelodysplastic syndromes (MDS) are a family of myeloid cancers with diverse genotypes and phenotypes characterized by ineffective haematopoiesis and risk of transformation to acute myeloid leukaemia (AML). Some epidemiological data indicate that MDS incidence is increasing in resource-rich regions but this is controversial. Most MDS cases are caused by randomly acquired somatic mutations. In some patients, the phenotype and/or genotype of MDS overlaps with that of bone marrow failure disorders such as aplastic anaemia, paroxysmal nocturnal haemoglobinuria (PNH) and AML. Prognostic systems, such as the revised International Prognostic Scoring System (IPSS-R), provide reasonably accurate predictions of survival at the population level. Therapeutic goals in individuals with lower-risk MDS include improving quality of life and minimizing erythrocyte and platelet transfusions. Therapeutic goals in people with higher-risk MDS include decreasing the risk of AML transformation and prolonging survival. Haematopoietic cell transplantation (HCT) can cure MDS, yet fewer than 10% of affected individuals receive this treatment. However, how, when and in which patients with HCT for MDS should be performed remains controversial, with some studies suggesting HCT is preferred in some individuals with higher-risk MDS. Advances in the understanding of MDS biology offer the prospect of new therapeutic approaches.
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Hochman MJ, DeZern AE. Myelodysplastic syndrome and autoimmune disorders: two sides of the same coin? Lancet Haematol 2022; 9:e523-e534. [PMID: 35772431 DOI: 10.1016/s2352-3026(22)00138-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
Systemic inflammatory and autoimmune diseases and myelodysplastic syndromes have been linked in individual patients and in larger case series for at least 25 years. These associations frequently include thyroid disease, neutrophilic dermatoses, polyarthritis, connective tissue diseases, vasculitis, and autoimmune cytopenias. Studies have found that autoimmune disease (or its therapy) is a risk factor for the development of myelodysplastic syndromes, but such syndromes might also be an instigator of autoimmune disease. Epidemiological studies examining disease risk in myelodysplastic syndromes with and without comorbid autoimmune illness have reached mixed conclusions. The pathophysiology of myelodysplastic syndromes is tightly linked to excessive inflammatory activity in the bone marrow microenvironment, which could promote systemic inflammatory and autoimmune diseases directly or by stimulation of the adaptive immune response. Alternatively, autoimmune diseases could promote clonal evolution and disordered bone marrow growth, promoting the development of myeloid malignancy. Additionally, therapy-related myeloid neoplasms-including myelodysplastic syndromes-have been diagnosed after treatment of autoimmune diseases with immunosuppressant therapies. These associations raise the following question: are myelodysplastic syndromes and systemic inflammatory and autoimmune diseases two sides of the same coin-that is, do they share an underlying disease state that can manifest as a myeloid neoplasm, an autoinflammatory illness, or both? VEXAS syndrome, which was first reported in 2020, is caused by a mutation that affects myeloid-restricted cells and manifests with both myelodysplasia and autoinflammation, and could give insight into this biological possibility. We note that systemic inflammatory and autoimmune diseases are often steroid-dependent; however, studies have also evaluated the roles of other immunomodulating therapies. In this Viewpoint, we critically appraise and review the literature on the epidemiology, pathophysiology, and management of systemic inflammatory and autoimmune diseases that are associated with myelodysplastic syndromes and related diseases.
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Affiliation(s)
- Michael J Hochman
- Division of Hematologic Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy E DeZern
- Division of Hematologic Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Shallis RM, Gore SD. Agent Orange and dioxin-induced myeloid leukemia: a weaponized vehicle of leukemogenesis. Leuk Lymphoma 2022; 63:1534-1543. [PMID: 35105250 DOI: 10.1080/10428194.2022.2034156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Agent Orange (AO) was the dominant weaponized herbicide employed by the United States (US) military during the Vietnam war. AO, however, was found to be regularly contaminated by 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the most toxic dioxin known; furthermore, AO was commonly diluted in the field with other aromatic hydrocarbons to assist with delivery mechanisms. Unbeknownst to the US military and the millions exposed, these events have likely contributed to the development of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) that has affected many veterans. Null studies regarding an association between AO exposure and AML/MDS are limited in their methodology and application. The acknowledgement that the known carcinogen TCDD was a contaminant in AO when paired with a strong biological plausibility for its leukemogenicity and an observed increased risk of AML/MDS in TCDD-exposed individuals should suffice to establish causal association and that veterans to whom this might apply should be awarded appropriate indemnity.
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Affiliation(s)
- Rory M Shallis
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - Steven D Gore
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
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7
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Linabery AM, Roesler MA, Richardson M, Warlick ED, Nguyen PL, Cioc AM, Poynter JN. Personal history of autoimmune disease and other medical conditions and risk of myelodysplastic syndromes. Cancer Epidemiol 2022; 76:102090. [PMID: 34995873 PMCID: PMC8792352 DOI: 10.1016/j.canep.2021.102090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Autoimmune diseases and hematopoietic malignancies are known to cluster within individuals, suggesting intertwined etiologies. A limited number of studies have evaluated pre-existing medical conditions as risk factors for myelodysplastic syndromes (MDS). We evaluated associations between autoimmune disease and other medical conditions and risk of MDS. METHODS Cases were identified through the Minnesota Cancer Reporting System. Controls were identified through the Minnesota State driver's license/identification card list. History of autoimmune disease and other medical conditions was based on self-report; proxy interviews were not conducted. Unconditional logistic regression was used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CI). RESULTS We included 395 cases and 694 controls. Cases were significantly more likely to report a diagnosis of any autoimmune disease when compared with controls (aOR=1.41, 95% CI: 1.05-1.89) after adjustment for age, sex, education, NSAID use, exposure to benzene and body mass index. When we evaluated specific autoimmune conditions, a statistically significant association was observed for hypothyroidism (aOR=2.16, 95% CI: 1.39-3.34) and odds ratios were elevated for inflammatory bowel disease (aOR=1.75) and systemic lupus erythematosus (SLE; aOR=3.65), although these associations did not reach statistical significance. Presence of an autoimmune condition did not impact overall survival (p = 0.91). CONCLUSION Our results validate previous findings of an association between autoimmune disease and MDS. Further studies are required to determine whether this association is due to shared etiology, treatment for autoimmune diseases, or altered immune surveillance or bone marrow damage caused by the autoimmune condition.
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Affiliation(s)
- Amy M Linabery
- Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; University of Minnesota Masonic Cancer Center, Minneapolis, MN, USA
| | - Michelle A Roesler
- Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Michaela Richardson
- Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Erica D Warlick
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Phuong L Nguyen
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Adina M Cioc
- Division of Hematopathology, VA Medical Center, Minneapolis, MN, USA
| | - Jenny N Poynter
- University of Minnesota Masonic Cancer Center, Minneapolis, MN, USA.
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Anwar N, Arshad A, Fatima N, Shaheen S, Bukhari S, Shamsi T. Environmental and occupational determinants of myelodysplastic syndrome: A case-control study from Pakistan. Cancer Rep (Hoboken) 2021; 5:e1580. [PMID: 34708590 PMCID: PMC9575501 DOI: 10.1002/cnr2.1580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/07/2021] [Accepted: 10/12/2021] [Indexed: 12/01/2022] Open
Abstract
Background Myelodysplastic syndromes (MDS) are heterogeneous group of haematopoietic stem cell disorders and have variable reduction in the production of red cells, platelets and mature granulocytes. Aim We conducted a case–control study evaluating the environmental and occupational determinants as risk factors of MDS. Methods A case–control study was conducted including 150 de novo MDS cases and 450 age and gender‐matched controls. Disease characteristics, sociodemographics and exposure to environmental and occupational determinants were collected through a questionnaire. Chi‐square test was applied to observe association, and binary logistic regression was applied to predict the odds of having MDS. Results A total of 600 participants were analysed. Those who were exposed to arsenic (OR 31.81, CI: 19.0–53.0, P‐value: .000), benzene (OR 1.564, CI: 1.07–2.27, P‐value: .01) using natural source of water (OR 3.563, CI: 2.29–5.53, P‐value: .000) and smokers (OR 3.1, P‐value: .000) were more likely to have MDS. Unmarried were less likely to acquire MDS than married (OR 0.239, CI: 0.15–0.36, P‐value: .000), Sindhi speaking were 1.419 times more likely to have MDS than participants speaking other languages. Uneducated participants were more likely to have MDS than educated and powder milk users were more likely to have MDS than dairy milk users. Conclusion Our results revealed that arsenic, use of natural source of water and benzene exposure might lead to higher risk of acquiring MDS. This study would be helpful to understand the aetiology of disease in Pakistani population.
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Affiliation(s)
- Nida Anwar
- National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Aisha Arshad
- National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Naveena Fatima
- National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Sumaira Shaheen
- National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Sumera Bukhari
- Cambridge Health Alliance Harvard Medical School, Cambridge, Massachusetts, USA
| | - Tahir Shamsi
- National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
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Mundt KA, Dell LD, Boffetta P, Beckett EM, Lynch HN, Desai VJ, Lin CK, Thompson WJ. The importance of evaluating specific myeloid malignancies in epidemiological studies of environmental carcinogens. BMC Cancer 2021; 21:227. [PMID: 33676443 PMCID: PMC7936449 DOI: 10.1186/s12885-021-07908-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 02/12/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Although myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), myeloproliferative neoplasms (MPN) - including chronic myeloid leukemia (CML) - and myelodysplastic/myeloproliferative neoplasms (MDS/MPN) are largely clinically distinct myeloid malignancies, epidemiological studies rarely examine them separately and often combine them with lymphoid malignancies, limiting possible etiological interpretations for specific myeloid malignancies. METHODS We systematically evaluated the epidemiological literature on the four chemical agents (1,3-butadiene, formaldehyde, benzene, and tobacco smoking, excluding pharmaceutical, microbial and radioactive agents, and pesticides) classified by the International Agency for Research on Cancer as having sufficient epidemiological evidence to conclude that each causes "myeloid malignancies." Literature searches of IARC Monographs and PubMed identified 85 studies that we critically assessed, and for appropriate subsets, summarized results using meta-analysis. RESULTS Only two epidemiological studies on 1,3-butadiene were identified, but reported findings were inadequate to evaluate specific myeloid malignancies. Studies on formaldehyde reported results for AML and CML - and not for MDS or MPN - but reported no increased risks. For benzene, several specific myeloid malignancies were evaluated, with consistent associations reported with AML and MDS and mixed results for CML. Studies of tobacco smoking examined all major myeloid malignancies, demonstrating consistent relationships with AML, MDS and MPN, but not with CML. CONCLUSIONS Surprisingly few epidemiological studies present results for specific myeloid malignancies, and those identified were inconsistent across studies of the same exposure, as well as across chemical agents. This exercise illustrates that even for agents classified as having sufficient evidence of causing "myeloid malignancies," the epidemiological evidence for specific myeloid malignancies is generally limited and inconsistent. Future epidemiological studies should report findings for the specific myeloid malignancies, as combining them post hoc - where appropriate - always remains possible, whereas disaggregation may not. Furthermore, combining results across possibly discrete diseases reduces the chances of identifying important malignancy-specific causal associations.
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Affiliation(s)
| | - L D Dell
- Ramboll US Consulting Inc., Amherst, MA, USA
| | - P Boffetta
- Stony Brook Cancer Center, Stony Brook, NY, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | | | - V J Desai
- Mount Sinai Hospital, New York, NY, USA
| | - C K Lin
- Cardno ChemRisk, Boston, MA, USA
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When Should We Think of Myelodysplasia or Bone Marrow Failure in a Thrombocytopenic Patient? A Practical Approach to Diagnosis. J Clin Med 2021; 10:jcm10051026. [PMID: 33801484 PMCID: PMC7958851 DOI: 10.3390/jcm10051026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 12/15/2022] Open
Abstract
Thrombocytopenia can arise from various conditions, including myelodysplastic syndromes (MDS) and bone marrow failure (BMF) syndromes. Meticulous assessment of the peripheral blood smear, identification of accompanying clinical conditions, and characterization of the clinical course are important for initial assessment of unexplained thrombocytopenia. Increased awareness is required to identify patients with suspected MDS or BMF, who are in need of further investigations by a step-wise approach. Bone marrow cytomorphology, histopathology, and cytogenetics are complemented by myeloid next-generation sequencing (NGS) panels. Such panels are helpful to distinguish reactive cytopenia from clonal conditions. MDS are caused by mutations in the hematopoietic stem/progenitor cells, characterized by cytopenia and dysplasia, and an inherent risk of leukemic progression. Aplastic anemia (AA), the most frequent acquired BMF, is immunologically driven and characterized by an empty bone marrow. Diagnosis remains challenging due to overlaps with other hematological disorders. Congenital BMF, certainly rare in adulthood, can present atypically with thrombocytopenia and can be misdiagnosed. Analyses for chromosome fragility, telomere length, and germline gene sequencing are needed. Interdisciplinary expert teams contribute to diagnosis, prognostication, and choice of therapy for patients with suspected MDS and BMF. With this review we aim to increase the awareness and provide practical approaches for diagnosis of these conditions in suspicious cases presenting with thrombocytopenia.
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Yarosh R, Roesler MA, Murray T, Cioc A, Hirsch B, Nguyen P, Warlick E, Poynter JN. Risk factors for de novo and therapy-related myelodysplastic syndromes (MDS). Cancer Causes Control 2021; 32:241-250. [PMID: 33392905 PMCID: PMC7878335 DOI: 10.1007/s10552-020-01378-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Myelodysplastic syndromes (MDS) are classified as de novo and therapy-related (tMDS). We evaluated associations between MDS risk factors separately for de novo and tMDS. METHODS The study population included 346 de novo MDS cases, 37 tMDS cases and 682 population controls frequency matched by age and sex. Polytomous logistic regression was performed to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS After adjustment, former smoking status (OR = 1.45, 95% CI: 1.10-1.93), personal history of autoimmune disease (OR = 1.34, 95% CI: 0.99-1.82) and exposure to benzene (OR = 1.48, 95% CI: 1.00-2.19) were associated with de novo MDS. Risk estimates for the associations between smoking, autoimmune disease, and benzene exposure were similar in magnitude but non-significant in tMDS cases. Among individuals with a previous diagnosis of cancer, de novo MDS cases and controls were more likely to have had a previous solid tumor, while tMDS cases more commonly had a previous hematologic malignancy. CONCLUSIONS We observed similar associations between smoking, history of autoimmune disease and benzene exposure in de novo and tMDS although estimates for tMDS were imprecise due to small sample sizes. Future analyses with larger sample sizes will be required to confirm whether environmental factors influence risk of tMDS.
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Affiliation(s)
- Rina Yarosh
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Thomas Murray
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | | | - Betsy Hirsch
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Phuong Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Erica Warlick
- Department of Medicine, Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Jenny N Poynter
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
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12
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Buch MH, Eyre S, McGonagle D. Persistent inflammatory and non-inflammatory mechanisms in refractory rheumatoid arthritis. Nat Rev Rheumatol 2020; 17:17-33. [PMID: 33293696 DOI: 10.1038/s41584-020-00541-7] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 12/13/2022]
Abstract
Despite nearly three decades of advances in the management of rheumatoid arthritis (RA), a substantial minority of patients are exposed to multiple DMARDs without necessarily benefitting from them; a group of patients variously designated as having 'difficult to treat', 'treatment-resistant' or 'refractory' RA. This Review of refractory RA focuses on two types of patients: those for whom multiple targeted therapies lack efficacy and who have persistent inflammatory pathology, which we designate as persistent inflammatory refractory RA (PIRRA); and those with supposed refractory RA who have continued disease activity that is predominantly independent of objective evidence of inflammation, which we designate as non-inflammatory refractory RA (NIRRA). These two types of disease are not mutually exclusive, but identifying those individuals with predominant PIRRA or NIRRA is important, as it informs distinct treatment and management approaches. This Review outlines the clinical differences between PIRRA and NIRRA, the genetic and epigenetic mechanisms and immune pathways that might contribute to the immunopathogenesis of recalcitrant synovitis in PIRRA, and a possible basis for non-inflammatory symptomatology in NIRRA. Future approaches towards the definition of refractory RA and the application of single-cell and integrated omics technologies to the identification of refractory RA endotypes are also discussed.
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Affiliation(s)
- Maya H Buch
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK. .,NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University Foundation Trust, Manchester, UK. .,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
| | - Stephen Eyre
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University Foundation Trust, Manchester, UK
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Carraway HE, LaFramboise T. Myeloid neoplasms with germline predisposition: Practical considerations and complications in the search for new susceptibility loci. Best Pract Res Clin Haematol 2020; 33:101191. [PMID: 33038980 DOI: 10.1016/j.beha.2020.101191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/27/2020] [Indexed: 12/20/2022]
Abstract
Genomic research in hematological malignancies has focused far more prominently on somatic mutations than on germline variants. Although increasing numbers of germline variants are being identified, a substantial proportion of familial myeloid malignancies have no causal allele pinpointed. Here we review the biological, technological, and clinical challenges that stand in the way of the goal of establishing, implementing, and interpreting a comprehensive panel of germline variants for testing. Achieving this goal would inform care for large numbers of myeloid malignancy patients. Furthermore, knowledge of germline susceptibility variants and their corresponding genes will shed light on disease processes, potentially suggesting therapeutic strategies tailored to specific variants.
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Affiliation(s)
- Hetty E Carraway
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
| | - Thomas LaFramboise
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, 10900, Euclid Avenue, Cleveland, OH, 44106, USA.
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14
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Alcohol use is not a significant contributor to myelodysplastic syndromes. Cancer Causes Control 2020; 31:549-557. [PMID: 32285234 DOI: 10.1007/s10552-020-01298-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 04/02/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Myelodysplastic syndromes (MDS) are a class of clonal neoplastic disorders of largely unknown etiology, and published data remain inconclusive regarding the association between lifetime alcohol consumption and MDS risk. In these analyses, data from a population-based case-control study were used to investigate this association. METHODS Eligible cases of MDS were identified through the Minnesota Cancer Reporting System; controls were matched by sex and age-decile. A central review process was used to confirm MDS diagnosis and classify subtypes. Unconditional and polytomous logistic regression were used to calculate odds ratios (OR) and 95% confidence intervals (CI). Kaplan-Meier curves were used to compare survival by category of lifetime alcohol consumption. RESULTS In total, 398 cases of MDS and 698 controls were included. Alcohol consumption at 23-30, 31-49, and 50-65 years of age, recent consumption 1 year before diagnosis/interview, and lifetime consumption were not found to be significantly associated with MDS in males (OR range 0.63-0.99) or females (OR range 0.58-1.70). Analysis by MDS subtype further suggested there was not a significant association between recent alcohol consumption and odds of disease by subtype (OR range 0.39-1.13). Lifetime alcohol consumption was not significantly associated with survival after diagnosis of MDS CONCLUSIONS: Previously reported associations between alcohol consumption and MDS risk were inconsistent. Results from our analyses by sex and disease subtype do not support alcohol as a significant contributor to risk of MDS.
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Autoimmune disease in CMML-the chicken or the egg? Best Pract Res Clin Haematol 2019; 33:101136. [PMID: 32460986 DOI: 10.1016/j.beha.2019.101136] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 12/14/2022]
Abstract
Chronic myelomonocytic leukemia (CMML) is a clonal disorder that is associated with a wide range of systemic inflammatory and autoimmune diseases (SIADs). Approximately 20% of patients with CMML will have an associated SIAD and recognizing this association is critical to the evaluation, prognostication and management of patients with CMML. In this paper, we review the evidence supporting a causative link between these two entities as well as the direction of this relationship. We argue that the data favors CMML as the antecedent and causative disease state with a few notable exceptions. Better understanding of this relationship aids clinicians in the education of their patients and in determining the optimal management approach at the bedside. It is important to recognize opportunities to harmonize the treatments of these disease processes, which may enhance the effectiveness of treatment while reducing the burden of adverse effects from redundant therapies.
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Sweeney MR, Applebaum KM, Arem H, Braffett BH, Poynter JN, Robien K. Medical Conditions and Modifiable Risk Factors for Myelodysplastic Syndrome: A Systematic Review. Cancer Epidemiol Biomarkers Prev 2019; 28:1502-1517. [DOI: 10.1158/1055-9965.epi-19-0106] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/13/2019] [Accepted: 06/13/2019] [Indexed: 11/16/2022] Open
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Abstract
Granulocytes are the major type of phagocytes constituting the front line of innate immune defense against bacterial infection. In adults, granulocytes are derived from hematopoietic stem cells in the bone marrow. Alcohol is the most frequently abused substance in human society. Excessive alcohol consumption injures hematopoietic tissue, impairing bone marrow production of granulocytes through disrupting homeostasis of granulopoiesis and the granulopoietic response. Because of the compromised immune defense function, alcohol abusers are susceptible to infectious diseases, particularly septic infection. Alcoholic patients with septic infection and granulocytopenia have an exceedingly high mortality rate. Treatment of serious infection in alcoholic patients with bone marrow inhibition continues to be a major challenge. Excessive alcohol consumption also causes diseases in other organ systems, particularly severe alcoholic hepatitis which is life threatening. Corticosteroids are the only therapeutic option for improving short-term survival in patients with severe alcoholic hepatitis. The existence of advanced alcoholic liver diseases and administration of corticosteroids make it more difficult to treat serious infection in alcoholic patients with the disorder of granulopoieis. This article reviews the recent development in understanding alcohol-induced disruption of marrow granulopoiesis and the granulopoietic response with the focus on progress in delineating cell signaling mechanisms underlying the alcohol-induced injury to hematopoietic tissue. Efforts in exploring effective therapy to improve patient care in this field will also be discussed.
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18
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Zeidan AM, Shallis RM, Wang R, Davidoff A, Ma X. Epidemiology of myelodysplastic syndromes: Why characterizing the beast is a prerequisite to taming it. Blood Rev 2019; 34:1-15. [DOI: 10.1016/j.blre.2018.09.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/01/2018] [Accepted: 09/17/2018] [Indexed: 02/08/2023]
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Slack J, Nguyen L, Naugler C, Rashid-Kolvear F. Incidence of Myelodysplastic Syndromes in a Major Canadian Metropolitan Area. J Appl Lab Med 2018; 3:378-383. [PMID: 33636921 DOI: 10.1373/jalm.2018.026500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/14/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal stem cell disorders that can progress to acute myeloid leukemia. In many regions of the world, the epidemiology of MDS is poorly described. This study determines the crude incidence of MDS in Calgary, Alberta, Canada, with new cases diagnosed using the revised 2008 WHO criteria. METHODS For the study period of January 1, 2011 to December 31, 2015, incident cases of MDS were identified from a centralized database maintained by Calgary Laboratory Services' Cancer Cytogenetics Laboratory, which receives and analyzes patient bone marrow samples from southern Alberta. RESULTS The Calgary metropolitan area had a total incidence rate of 2.60 MDS cases per 100000 person years, corresponding to an age-standardized incidence of 3.69 for Canada. The male-to-female sex ratio was 1.35, and the median age at diagnosis was 75 years. With these results, 1295 new annual cases of MDS were predicted in Canada. CONCLUSIONS The reported incidence rate, sex, and age distribution were consistent with data around the world including several developing nations. This is the first study to provide information regarding the epidemiology of MDS within Canada.
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Affiliation(s)
- Jonathan Slack
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Calgary Laboratory Services, Calgary, AB, Canada
| | - Leonard Nguyen
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Calgary Laboratory Services, Calgary, AB, Canada.,Departments of Family Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Fariborz Rashid-Kolvear
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Calgary Laboratory Services, Calgary, AB, Canada
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Li W, Schnatter AR. Benzene risk assessment: does new evidence on myelodysplastic syndrome justify a new approach? Crit Rev Toxicol 2018; 48:417-432. [DOI: 10.1080/10408444.2018.1437389] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Wenchao Li
- Occupational and Public Health Division, ExxonMobil Biomedical Sciences Inc., Annandale, NJ, USA
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - A. Robert Schnatter
- Occupational and Public Health Division, ExxonMobil Biomedical Sciences Inc., Annandale, NJ, USA
- EpiSolutions, LLC, Easton, PA, USA
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21
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Abstract
OBJECTIVE Due to the sparse data on benzene exposure and myelodysplastic syndrome (MDS) subtypes, we studied this relationship in patients from 29 hospitals in Shanghai, China. METHODS We recruited 604 cases of MDS and 1193 controls matched on age, sex, and admission date. We interviewed subjects for information on workplace and lifestyle exposures, and developed semi-quantitative exposure estimates. RESULTS Benzene exposure showed a direct exposure-response pattern with refractory cytopenia with multilineage dysplasia, a less certain association with refractory cytopenia with unilineage dysplasia, and no association with other MDS subtypes. A different pattern was observed with farm residence and smoking, which was primarily related to refractory anemias. CONCLUSIONS This research demonstrates the importance of MDS subtype specification for more robust etiologic insights. Our data suggests that subtypes with non-erythroid dysplasia are associated with benzene exposure.
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Heuser M, Thol F, Ganser A. Clonal Hematopoiesis of Indeterminate Potential. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 113:317-22. [PMID: 27215596 DOI: 10.3238/arztebl.2016.0317] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/23/2015] [Accepted: 11/23/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with cytopenia are increasingly undergoing molecular genetic tests of periperal blood or bone marrow for diagnostic purposes. These tests can detect genetic mutations that do not have any morphological correlate in hematologic neoplasia such as myelo - dysplastic syndrome (MDS). A new entity was recently defined to lessen the risk of incorrect diagnoses of MDS. This new entity is a potential precursor of myeloid diseases, analogously to monoclonal gammopathy of undetermined significance as a potential precursor of multiple myeloma. METHODS This review is based on pertinent articles retrieved by a selective search in PubMed employing the terms "clonal hematopoiesis," "acute myeloid leukemia," and "myelodysplastic syndrome." RESULTS Clonal hematopoiesis of indeterminate potential (CHIP) is a new entity in which somatic mutations are found in cells of the blood or bone marrow, but no other criteria for hematologic neoplasia are met. Its prevalence rises with age and is roughly 10% among persons aged 70 to 80. It is estimated that, in Germany, about 2.75 million people are affected. The most common mutation is on the DNMT3A gene, followed by TET2 and ASXL1. The rate of transformation to a hematological neoplasia is 0.5-1% per year, and thus about 13 times higher than the incidence of such neoplasias in general. If CHIP is discovered incidentally in a patient with a normal blood count, a complete blood count with differential should be repeated three months later and then at annual intervals. CONCLUSION CHIP must be included in the differential diagnosis of peripheral blood cytopenia. This new entity can help us understand the clinical significance of clonal hematopoiesis.
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Affiliation(s)
- Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School
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Ugai T, Matsuo K, Sawada N, Iwasaki M, Yamaji T, Shimazu T, Sasazuki S, Inoue M, Kanda Y, Tsugane S. Smoking and alcohol and subsequent risk of myelodysplastic syndromes in Japan: the Japan Public Health Centre-based Prospective Study. Br J Haematol 2017; 178:747-755. [DOI: 10.1111/bjh.14749] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/25/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Tomotaka Ugai
- Division of Molecular and Clinical Epidemiology; Aichi Cancer Centre Research Institute; Nagoya Japan
- Division of Haematology; Saitama Medical Centre; Jichi Medical University; Saitama Japan
| | - Keitaro Matsuo
- Division of Molecular and Clinical Epidemiology; Aichi Cancer Centre Research Institute; Nagoya Japan
- Department of Epidemiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Norie Sawada
- Epidemiology and Prevention Group; Centre for Public Health Sciences; National Cancer Centre; Tokyo Japan
| | - Motoki Iwasaki
- Epidemiology and Prevention Group; Centre for Public Health Sciences; National Cancer Centre; Tokyo Japan
| | - Taiki Yamaji
- Epidemiology and Prevention Group; Centre for Public Health Sciences; National Cancer Centre; Tokyo Japan
| | - Taichi Shimazu
- Epidemiology and Prevention Group; Centre for Public Health Sciences; National Cancer Centre; Tokyo Japan
| | - Shizuka Sasazuki
- Epidemiology and Prevention Group; Centre for Public Health Sciences; National Cancer Centre; Tokyo Japan
| | - Manami Inoue
- Epidemiology and Prevention Group; Centre for Public Health Sciences; National Cancer Centre; Tokyo Japan
- Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Yoshinobu Kanda
- Division of Haematology; Saitama Medical Centre; Jichi Medical University; Saitama Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group; Centre for Public Health Sciences; National Cancer Centre; Tokyo Japan
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Ugai T, Matsuo K, Oze I, Ito H, Wakai K, Wada K, Nagata C, Nakayama T, Liu R, Kitamura Y, Tamakoshi A, Tsuji I, Sugawara Y, Sawada N, Sadakane A, Tanaka K, Mizoue T, Inoue M, Tsugane S, Shimazu T. Smoking and subsequent risk of acute myeloid leukaemia: A pooled analysis of 9 cohort studies in Japan. Hematol Oncol 2017; 36:262-268. [DOI: 10.1002/hon.2457] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 06/06/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Tomotaka Ugai
- Division of Molecular and Clinical Epidemiology; Aichi Cancer Center Research Institute; Nagoya Japan
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Keitaro Matsuo
- Division of Molecular and Clinical Epidemiology; Aichi Cancer Center Research Institute; Nagoya Japan
- Department of Epidemiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Isao Oze
- Division of Molecular and Clinical Epidemiology; Aichi Cancer Center Research Institute; Nagoya Japan
| | - Hidemi Ito
- Division of Molecular and Clinical Epidemiology; Aichi Cancer Center Research Institute; Nagoya Japan
- Department of Epidemiology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Kenji Wakai
- Department of Preventive Medicine; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Keiko Wada
- Department of Epidemiology and Preventive Medicine; Gifu University Graduate School of Medicine; Gifu Japan
| | - Chisato Nagata
- Department of Epidemiology and Preventive Medicine; Gifu University Graduate School of Medicine; Gifu Japan
| | - Tomio Nakayama
- Center for Cancer Control and Statistics; Osaka Medical Center for Cancer and Cardiovascular Diseases; Osaka Japan
| | - Rong Liu
- Department of Social and Environmental Medicine; Osaka University Graduate School of Medicine; Osaka Japan
| | - Yuri Kitamura
- Department of Social and Environmental Medicine; Osaka University Graduate School of Medicine; Osaka Japan
| | - Akiko Tamakoshi
- Department of Public Health; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Ichiro Tsuji
- Division of Epidemiology, Department of Public Health and Forensic Medicine; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Yumi Sugawara
- Division of Epidemiology, Department of Public Health and Forensic Medicine; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Norie Sawada
- Epidemiology and Prevention Group, Center for Public Health Sciences; National Cancer Center; Tokyo Japan
| | - Atsuko Sadakane
- Department of Epidemiology; Radiation Effects Research Foundation; Hiroshima Japan
| | - Keitaro Tanaka
- Department of Preventive Medicine, Faculty of Medicine; Saga University; Saga Japan
| | - Tetsuya Mizoue
- Department of Epidemiology and International Health, International Clinical Research Center; National Center for Global Health and Medicine; Tokyo Japan
| | - Manami Inoue
- Epidemiology and Prevention Group, Center for Public Health Sciences; National Cancer Center; Tokyo Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences; National Cancer Center; Tokyo Japan
| | - Taichi Shimazu
- Epidemiology and Prevention Group, Center for Public Health Sciences; National Cancer Center; Tokyo Japan
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Cull AH, Rauh MJ. Success in bone marrow failure? Novel therapeutic directions based on the immune environment of myelodysplastic syndromes. J Leukoc Biol 2017; 102:209-219. [DOI: 10.1189/jlb.5ri0317-083r] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/03/2017] [Accepted: 05/04/2017] [Indexed: 11/24/2022] Open
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26
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Avgerinou C, Giannezi I, Theodoropoulou S, Lazaris V, Kolliopoulou G, Zikos P, Alamanos Y, Leotsinidis M, Symeonidis A. Occupational, dietary, and other risk factors for myelodysplastic syndromes in Western Greece. ACTA ACUST UNITED AC 2017; 22:419-429. [PMID: 28102107 DOI: 10.1080/10245332.2016.1277006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE We have observed an increasing incidence of myelodysplastic syndromes (MDS) in the geographic area of Western Greece during the past two decades. The objective of this study was to investigate potential risk factors for the manifestation of MDS in this area of Greece. METHODS A hospital-based case-control study was conducted in the public hospitals of the region. Participants were interviewed based on a questionnaire regarding demographics, occupational exposures, smoking, alcohol consumption, dietary, and domestic factors. RESULTS A total of 228 individuals (126 cases, 102 controls) were recruited in this study. Univariate analysis showed that risk of MDS was associated with a family history of hematologic malignancy or solid tumor, exposure to pesticides, insecticides, herbicides, increased weekly intake of meat and eggs, and increased alcohol intake, whereas fruit intake had a protective effect. Analysis by pesticide ingredient showed a weak association of exposure to paraquat and glyphosate with the occurrence of MDS. Multivariate analysis showed that independent risk factors for the manifestation of MDS were family history of solid tumor (OR 2.47, 95% CI 1.32-4.65), meat intake for ≥5 days/week (OR 2.67, 95% CI 1.05-6.80) and exposure to pesticides (OR 3.25, 95% CI 1.73-6.11). CONCLUSIONS Exposure to pesticides is a major risk factor of MDS in Western Greece. Family history of solid tumor and increased meat intake also appear to play a role in the pathogenesis of MDS. Public health authorities should implement policies to advise and protect farmers from the harmful effects of agrochemicals. Emphasis should also be given to health promotion advice including healthy eating.
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Affiliation(s)
- Christina Avgerinou
- a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece.,b Laboratory of Public Health , Medical School, University of Patras , Greece
| | - Ioanna Giannezi
- a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece
| | - Stela Theodoropoulou
- a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece
| | - Vasileios Lazaris
- a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece
| | - Georgia Kolliopoulou
- a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece
| | - Panagiotis Zikos
- c Department of Hematology , 'St Andrew' General Hospital , Patras , Greece
| | - Yannis Alamanos
- b Laboratory of Public Health , Medical School, University of Patras , Greece
| | | | - Argiris Symeonidis
- a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece
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Poynter JN, Richardson M, Roesler M, Blair CK, Hirsch B, Nguyen P, Cioc A, Cerhan JR, Warlick E. Chemical exposures and risk of acute myeloid leukemia and myelodysplastic syndromes in a population-based study. Int J Cancer 2017; 140:23-33. [PMID: 27603749 PMCID: PMC5245124 DOI: 10.1002/ijc.30420] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 08/19/2016] [Indexed: 01/04/2023]
Abstract
Benzene exposure is one of the few well-established risk factors for myeloid malignancy. Exposure to other chemicals has been inconsistently associated with hematologic malignancies. We evaluated occupational and residential chemical exposures as risk factors for acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) using population-based data. AML and MDS cases were identified by the Minnesota Cancer Surveillance System. Controls were identified through the Minnesota driver's license/identification card list. Chemical exposures were measured by self-report. Unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CI). We included 265 MDS cases, 420 AML cases and 1388 controls. We observed significant associations between both MDS and AML and benzene (OR = 1.77, 95% CI 1.19, 2.63 and OR = 2.10, 95% CI 1.35, 3.28, respectively) and vinyl chlorides (OR = 2.05, 95% CI 1.15, 3.63 and OR = 2.81, 95% CI 1.14, 6.92). Exposure to soot, creosote, inks, dyes and tanning solutions and coal dust were associated with AML (range ORs = 2.68-4.03), while no association was seen between these exposures and MDS (range ORs = 0.57-1.68). Pesticides and agricultural chemicals were not significantly associated with AML or MDS. Similar results were observed in analyses stratified by sex. In addition to providing risk estimates for benzene from a population-based sample, we also identified a number of other occupational and residential chemicals that were significantly associated with AML; however, all exposures were reported by only a small percentage of cases (≤10%). While chemical exposures play a clear role in the etiology of myeloid malignancy, these exposures do not account for the majority of cases.
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Affiliation(s)
- Jenny N. Poynter
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Michaela Richardson
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Michelle Roesler
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Betsy Hirsch
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Phuong Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - James R. Cerhan
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Erica Warlick
- Blood and Marrow Transplant Program, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN
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Poynter JN, Richardson M, Langer E, Hooten AJ, Roesler M, Hirsch B, Nguyen PL, Cioc A, Warlick E, Ross JA. Association between mitochondrial DNA haplogroup and myelodysplastic syndromes. Genes Chromosomes Cancer 2016; 55:688-93. [PMID: 27121678 DOI: 10.1002/gcc.22370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/22/2016] [Accepted: 04/23/2016] [Indexed: 11/06/2022] Open
Abstract
Polymorphisms in mitochondrial DNA (mtDNA) are used to group individuals into haplogroups reflecting human global migration and are associated with multiple diseases, including cancer. Here, we evaluate the association between mtDNA haplogroup and risk of myelodysplastic syndromes (MDS). Cases were identified by the Minnesota Cancer Surveillance System. Controls were identified through the Minnesota State driver's license/identification card list. Because haplogroup frequencies vary by race and ethnicity, we restricted analyses to non-Hispanic whites. We genotyped 15 mtSNPs that capture common European mitochondrial haplogroup variation. We used SAS v.9.3 (SAS Institute, Cary, NC) to calculate odds ratios (OR) and 95% confidence intervals (CI) overall and stratified by MDS subtype and IPSS-R risk category. We were able to classify 215 cases with confirmed MDS and 522 controls into one of the 11 common European haplogroups. Due to small sample sizes in some subgroups, we combined mt haplogroups into larger bins based on the haplogroup evolutionary tree, including HV (H + V), JT (J + T), IWX (I + W + X), UK (U + K), and Z for comparisons of cases and controls. Using haplogroup HV as the reference group, we found a statistically significant association between haplogroup JT and MDS (OR = 0.58, 95% CI 0.36, 0.92, P = 0.02). No statistically significant heterogeneity was observed in subgroup analyses. In this population-based study of MDS, we observed an association between mtDNA haplogroup JT and risk of MDS. While previously published studies provide biological plausibility for the observed association, further studies of the relationship between mtDNA variation and MDS are warranted in larger sample sizes. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jenny N Poynter
- Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Michaela Richardson
- Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Erica Langer
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Anthony J Hooten
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Michelle Roesler
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Betsy Hirsch
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Phuong L Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Adina Cioc
- VA Medical Center, Minneapolis, Minnesota
| | - Erica Warlick
- Blood and Marrow Transplant Program, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Julie A Ross
- Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
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Abstract
Myelodysplastic syndrome (MDS) encompasses a heterogeneous group of diseases originating in hematopoietic stem cells and is characterized by inefficient hematopoiesis and dysplastic changes in the bone marrow. In peripheral blood patients show anemia (mostly macrocytic), frequently accompanied by neutropenia and thrombocytopenia. Thus, clinically the patients suffer from fatigue (anemia), increased bleeding (thrombocytopenia) and infectious complications (neutropenia). Approximately one quarter of MDS patients develop acute myeloid leukemia (AML) in the course of the disease, which is characterized by a 20 % or more increase of blasts in the bone marrow. The estimated overall survival as well as the risk for AML transformation can be calculated with the international prognostic scoring system (IPSS) as well as the revised IPSS score (IPSS-R). Novel sequencing methods (e.g. next generation sequencing) allow the detection of recurrent gene mutations in MDS patients. Genes of the splicing machinery as well as genes involved in epigenetic regulation (e.g. ASXL1 and TET2) are most frequently mutated in MDS. Therapy is selected based on the patient risk profile (IPSS). Allogeneic stem cell transplantation is a curative approach for high risk patients (i.e. IPSS int-2 and higher) with a good performance status and a biological age below 70 years. Otherwise, high risk patients are treated with demethylating agents (e.g. decitabine and azacitidine). Low risk patients (IPSS low and int-1) mainly receive supportive therapy including iron chelation. An exceptional position is presented by MDS with an isolated 5q deletion as it can be treated with lenalidomide with good success. Enrolling patients in clinical trials is strongly recommended to improve the prospects of this disease.
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Affiliation(s)
- F Thol
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland,
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30
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Abstract
Isoflavones have been suggested to have protective effects on certain cancers. However, the association of soya foods or dietary isoflavones with the risk of myelodysplastic syndromes (MDS) has not been examined. Thus, the aim of this hospital-based case-control study undertaken in China in 2012-2013 was to investigate the association between dietary isoflavone intake and MDS risk. The analysis included 208 cases aged 19-85 years with MDS and 208 controls individually matched to the cases by sex, birth quinquennium and residential locality. Information on habitual food intakes, including nine items of soya foods, was sought from in-person interviews using a validated 107-item FFQ. Dietary intakes of daidzein, genistein, glycitein and total isoflavones were estimated using the 2008 US Department of Agriculture Isoflavone Database. OR were calculated from conditional logistic regression after adjustment for potential confounding by demographics, lifestyle and dietary factors. The mean daily intake of total isoflavones was 19·0 mg in cases and 23·0 mg in controls. Dietary intake of isoflavones was inversely associated with the risk of MDS. The adjusted OR in the highest tertile compared with the lowest tertile of intake were 0·43 (95 % CI 0·21, 0·85) for daidzein, 0·36 (95 % CI 0·18, 0·74) for genistein, 0·49 (95 % CI 0·25, 0·97) for glycitein and 0·40 (95 % CI 0·20, 0·81) for total isoflavones. The findings suggest that higher dietary intake of isoflavones is associated with a reduced risk of MDS in a Chinese population.
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Alcohol consumption and risk of myelodysplastic syndromes: a case–control study. Cancer Causes Control 2015; 27:209-16. [DOI: 10.1007/s10552-015-0698-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/14/2015] [Indexed: 10/22/2022]
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Lindholm Sørensen A, Hasselbalch HC. Smoking and philadelphia-negative chronic myeloproliferative neoplasms. Eur J Haematol 2015; 97:63-9. [DOI: 10.1111/ejh.12684] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2015] [Indexed: 01/14/2023]
Affiliation(s)
- Anders Lindholm Sørensen
- Department of Haematology; Copenhagen University Hospital Roskilde; Copenhagen Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Hans Carl Hasselbalch
- Department of Haematology; Copenhagen University Hospital Roskilde; Copenhagen Denmark
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Duchmann M, Fenaux P, Cluzeau T. [Management of myelodysplastic syndromes]. Bull Cancer 2015; 102:946-57. [PMID: 26410692 DOI: 10.1016/j.bulcan.2015.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/25/2015] [Accepted: 07/10/2015] [Indexed: 12/16/2022]
Abstract
Myelodysplastic syndromes are heterogeneous diseases whose molecular characteristics have only been identified in recent years. Better identification of prognostic factors, larger access to allogeneic stem cell transplantation and the advent of new drugs notably hypomethylating agents (azacitidine, decitabine) and lenalidomide have improved patient outcome.
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Affiliation(s)
| | - Pierre Fenaux
- Université Paris 7, Assistance publique des Hôpitaux de Paris, hôpital Saint-Louis, service d'hématologie séniors, 75010 Paris, France
| | - Thomas Cluzeau
- Assistance publique des Hôpitaux de Paris, hôpital Saint-Louis, service d'hématologie, 75010 Paris, France; Centre méditerranéen de médecine moléculaire, Inserm U1065, 06204 Nice, France.
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Wang P, Liu H, Jiang T, Yang J. Cigarette Smoking and the Risk of Adult Myeloid Disease: A Meta-Analysis. PLoS One 2015; 10:e0137300. [PMID: 26340093 PMCID: PMC4560392 DOI: 10.1371/journal.pone.0137300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 07/21/2015] [Indexed: 12/30/2022] Open
Abstract
Background The adult myeloid diseases, myelodysplastic syndrome and acute myeloid leukemia, have been reported to be associated with cigarette smoking, but the results have been conflicting. Previous studies may have ignored the relationship between myelodysplastic syndrome and acute myeloid leukemia, where approximately one-third of myelodysplastic syndrome cases will progress to acute myeloid leukemia, which could induce a serious bias in independent analyses. For the purposes of researching pathogenesis, we suggest that myelodysplastic syndrome and acute myeloid leukemia should be regarded as a single class of adult myeloid disease, and herein assessed the relationship between cigarette smoking and the risk of adult myeloid disease. Methods The PubMed, Cochrane Library, EBSCO, and EMBASE databases were systematically searched for reports published from 1990 to 2015. Two authors independently assessed the methodological quality and the extracted data. The odds ratios and adjusted odds ratios (OR), a sensitivity analysis, and the publication bias were analyzed using the CMA v2 (Comprehensive Meta Analysis Version 2) software program. Results Twenty-five studies were included in this meta-analysis. The publication dates ranged from 1990 to 2014. The pooled OR in current smokers and ever-smokers showed an increased risk of adult myeloid disease, with ORs of 1.45 (95% CI, 1.30–1.62; p<0.001) and 1.23 (95% CI 1.15–1.32; p<0.001) versus non-smokers, respectively. In the subset analyses, the OR of adult myeloid disease was increased regardless of the form of disease, geographical region, NOS (Newcastle Ottawa Scale) score, and source of controls. The smoking status was divided into <20 and ≥20 cigarettes per day, and these groups had ORs of developing adult myeloid disease of 1.24 (95% CI, 1.09–1.40; p = 0.001) and 1.32 (95% CI, 1.14–1.53; p<0.001), respectively. In the groups divided based on the number of years the subjects had smoked (<20 and ≥20 years), the ORs were 1.05 (95% CI, 0.90–1.23; p = 0.25) and 1.30 (95% CI, 1.16–1.45; p<0.001), respectively. Similarly, <20 and ≥20 pack-years were associated with ORs of 1.15 (95% CI, 1.03–1.29; p = 0.017) and 1.34 (95% CI, 1.18–1.52; p<0.001), respectively. Conclusions This meta-analysis, for the first time, combined myelodysplastic syndrome with acute myeloid leukemia to assess the overall risk of adult myeloid disease, and it demonstrated that cigarette smoking is associated with a significantly increased risk of adult myeloid disease.
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Affiliation(s)
- Peng Wang
- Department of Pathology, Medical Faculty, Kunming University of Science and Technology, Kunming, P.R. China
| | - Huifang Liu
- Department of Pathology, Medical Faculty, Kunming University of Science and Technology, Kunming, P.R. China
| | - Ting Jiang
- Department of Pathology, Kunming General Hospital, Clinical College of Kunming Medical University, Kunming, P.R. China
| | - Julun Yang
- Department of Pathology, Medical Faculty, Kunming University of Science and Technology, Kunming, P.R. China; Department of Pathology, Kunming General Hospital, Kunming, P.R. China
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Liu B, Kerath SM, Sekeres MA, Fryzek JP, Sreekantaiah C, Mason CR, Kolitz J, Taioli E. Myelodysplastic syndromes spatial clusters in disease etiology and outcome. Leuk Lymphoma 2015; 57:392-399. [PMID: 26159047 DOI: 10.3109/10428194.2015.1071487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The myelodysplastic syndromes (MDS) are a heterogeneous group of hematopoietic disorders. This study aims to advance the use of spatial modeling in disease etiology and monitoring based on reports on a large population (n = 984) of MDS patients diagnosed in the Eastern United States. The spatial MDS clustering was analyzed using SaTScan, and patient clinical characteristics were analyzed using logistic regression and Cox hazards models adjusting for covariates. One main and five secondary spatial clusters (p-value < 10-17-10-7) were identified. Patients living in high vs. low MDS incidence clusters tended to be older (ORadj = 1.04 [1.004, 1.07]) and smokers (ORadj = 2.9 [1.1, 7.4]). Mortality was associated with hemoglobin (HRadj = 0.7 [0.5, 0.9]), neutrophils (HRadj = 0.7 [0.6, 0.96]), platelets (HRadj = 0.5 [0.4, 0.7]), and blast (HRadj = 1.4 [1.1, 1.8]), but not clusters. The results suggest large geographic variations in MDS incidence rates. The biological aggressiveness of the disease is unlikely to be associated with its spatial distribution.
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Affiliation(s)
- Bian Liu
- a Department of Population Health Science and Policy , Icahn School of Medicine at Mount Sinai , NY , USA
| | - Samantha M Kerath
- b Department of Population Health , The Feinstein Institute for Medical Research, Hofstra North Shore-LIJ School of Medicine , NY , USA
| | | | | | | | - Christopher R Mason
- f Department of Hematologic Oncology , North Shore-LIJ Health System , NY , USA
| | - Jonathan Kolitz
- f Department of Hematologic Oncology , North Shore-LIJ Health System , NY , USA
| | - Emanuela Taioli
- a Department of Population Health Science and Policy , Icahn School of Medicine at Mount Sinai , NY , USA
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Tea consumption reduces the risk of de novo myelodysplastic syndromes. Leuk Res 2015; 39:164-9. [DOI: 10.1016/j.leukres.2014.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 09/28/2014] [Accepted: 11/23/2014] [Indexed: 11/21/2022]
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Jin J, Yu M, Hu C, Ye L, Xie L, Jin J, Chen F, Tong H. Pesticide exposure as a risk factor for myelodysplastic syndromes: a meta-analysis based on 1,942 cases and 5,359 controls. PLoS One 2014; 9:e110850. [PMID: 25335083 PMCID: PMC4204937 DOI: 10.1371/journal.pone.0110850] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 09/19/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Pesticide exposure has been linked to increased risk of cancer at several sites, but its association with risk of myelodysplastic syndromes (MDS) is still unclear. A meta-analysis of studies published through April, 2014 was performed to investigate the association of pesticide exposure with the risk of MDS. METHODS Studies were identified by searching the Web of Science, Cochrane Library and PubMed databases. Summary odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated using random- or fixed-effect models. RESULTS This meta-analysis included 11 case-control studies, all of which demonstrated a correlation between pesticide exposure and a statistically significant increased risk of MDS (OR=1.95, 95% CI 1.23-3.09). In subgroup analyses, patients with pesticide exposure had increased risk of developing MDS if they were living in the Europe or Asia and had refractory anemia (RA) or RA with ringed sideroblasts (RARS). Moreover, in the analysis by specific pesticides, increased risk was associated with exposure to insecticides (OR=1.71, 95% CI 1.22-2.40) but not exposure to herbicides or fungicides. CONCLUSION This meta-analysis supports the hypothesis that exposure to pesticides increases the risk of developing MDS. Further prospective cohort studies are warranted to verify the association and guide clinical practice in MDS prevention.
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Affiliation(s)
- Jie Jin
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Mengxia Yu
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Chao Hu
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Li Ye
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Lili Xie
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jin Jin
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Feifei Chen
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Hongyan Tong
- Department of Hematology, the First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
- Myelodysplastic syndromes diagnosis and therapy center, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
- * E-mail:
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Wong JJL, Lau KA, Pinello N, Rasko JEJ. Epigenetic modifications of splicing factor genes in myelodysplastic syndromes and acute myeloid leukemia. Cancer Sci 2014; 105:1457-63. [PMID: 25220401 PMCID: PMC4462368 DOI: 10.1111/cas.12532] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/28/2014] [Accepted: 09/01/2014] [Indexed: 12/19/2022] Open
Abstract
Somatic mutations in splicing factor genes have frequently been reported in myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). Although aberrant epigenetic changes are frequently implicated in blood cancers, their direct role in suppressing one or both alleles of critical splicing factors has not been previously examined. Here, we examined promoter DNA hypermethylation of nine splicing factors, SF3B1, SRSF2, U2AF1, ZRSR2, SF3A1, HNRNPR, MATR3, ZFR, and YBX3 in 10 leukemic cell lines and 94 MDS or AML patient samples from the Australasian Leukemia and Lymphoma Group Tissue Bank. The only evidence of epigenetic effects was hypermethylation of the YBX3 promoter in U937 cells in conjunction with an enrichment of histone marks associated with gene silencing. In silico analysis of DNA methylation data for 173 AML samples generated by the Cancer Genome Atlas Research Network revealed promoter hypermethylation of the gene encoding Y box binding protein 3, YBX3, in 11/173 (6.4%) AML cases, which was significantly associated with reduced mRNA expression (P < 0.0001). Hypermethylation of the ZRSR2 promoter was also detected in 7/173 (4%) cases but was not associated with decreased mRNA expression (P = 0.1204). Hypermethylation was absent at the promoter of seven other splicing factor genes in all cell lines and patient samples examined. We conclude that DNA hypermethylation does not frequently silence splicing factors in MDS and AML. However, in the case of YBX3, promoter hypermethylation-induced downregulation may contribute to the pathogenesis or maintenance of AML.
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Affiliation(s)
- Justin J-L Wong
- Gene and Stem Cell Therapy Program, Centenary Institute, Camperdown, New South Wales, Australia; Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
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Abstract
PURPOSE OF REVIEW Myelodysplastic/myeloproliferative neoplasms (MDS/MPNs), including chronic myelomonocytic leukemia, atypical chronic myeloid leukemia, MDS/MPN-Unclassifiable, ring sideroblasts associated with marked thrombocytosis, and juvenile myelomonocytic leukemia, are clonal hematologic diseases characterized by myeloid dysplasia, proliferation, and absence of the molecular lesions BCR/ABL, PDGFRA, PDGFRB, and FGFR1. There are currently no US Food and Drug Administration approved therapies for all MDS/MPN subtypes. Advances in the understanding of the biologic and molecular drivers of these diseases will help in diagnosis, prognosis, and therapeutics. This review article summarizes the molecular aspects of MDS/MPNs and provides an overview of classic and emerging therapies. RECENT FINDINGS Next generation sequencing has provided new insights into the genetic nature of MDS/MPNs. Molecular mutations such as TET2, CBL, SETBP1, CSF3R, and SF3B1 are relevant as diagnostic and prognostic biomarkers. Hematopoietic cell transplantation, although potentially curative, is applicable to only a small proportion of patients. Attempts to standardize response and outcomes criteria specific to MDS/MPN and clinical trials using novel agents focused on MDS/MPN patients are underway. SUMMARY MDS/MPNs have clinicopathologic features of both MDS and MPN diseases. Emerging molecular data support the distinctive disease biology of each of these morphologic entities, and will serve as the foundation to develop effective therapeutics that can ameliorate disease-related complications and lead to better outcomes.
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I Walk the Other Line: Myelodysplastic/Myeloproliferative Neoplasm Overlap Syndromes. Curr Hematol Malig Rep 2014; 9:400-6. [DOI: 10.1007/s11899-014-0233-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jin J, Yu M, Hu C, Ye L, Xie L, Chen F, Zhuang Z, Tong H. Alcohol consumption and risk of myelodysplastic syndromes: A meta-analysis of epidemiological studies. Mol Clin Oncol 2014; 2:1115-1120. [PMID: 25279208 DOI: 10.3892/mco.2014.376] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 07/22/2014] [Indexed: 11/05/2022] Open
Abstract
Previous studies on the association between alcohol intake and the risk of myelodysplastic syndromes (MDS) have been inconclusive. We conducted a meta-analysis to evaluate alcohol intake as a risk factor for MDS. We performed a systematic literature search of articles published before March, 2014 using Web of Science, PubMed and the Cochrane Library. Two evaluators independently selected and reviewed studies based on predetermined selection criteria. The fixed- or random-effects models were used to summarize the estimates of odds ratios (ORs) with 95% confidence intervals (CIs). A total of 9 studies (8 case-control and 1 cohort) met the inclusion criteria of this meta-analysis. No significant association was observed between alcohol consumption and MDS when comparing drinkers to non-drinkers (OR=1.16, 95% CI: 0.88-1.53) or between subgroups stratified by alcohol history, gender, ethnicity, study design, source of patients or MDS subtypes. However, the data indicated a stronger association of alcohol with MDS in individuals who consumed ≥10 g/day (OR=1.55, 95% CI: 1.08-2.21) vs. those who consumed <10 g/day (OR=1.09, 95% CI: 0.78-1.53). This meta-analysis suggests that alcohol intake may increase the risk of MDS in a dose-dependent manner. However, additional well-designed, prospective cohort studies are required to verify these findings and identify other risk factors associated with MDS.
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Affiliation(s)
- Jie Jin
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Mengxia Yu
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Chao Hu
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Li Ye
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Lili Xie
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Feifei Chen
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Zhengping Zhuang
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Hongyan Tong
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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Samiev D, Bhatt VR, Armitage JD, Maness LJ, Akhtari M. A primary care approach to myelodysplastic syndromes. Korean J Fam Med 2014; 35:111-8. [PMID: 24921029 PMCID: PMC4040428 DOI: 10.4082/kjfm.2014.35.3.111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 04/14/2014] [Indexed: 11/29/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are probably the most common hematologic malignancies in adults over the age of 60 and are a major source of morbidity and mortality among older age groups. Diagnosis and management of this chronic blood cancer has evolved significantly in recent years and there are Food and Drug Administration-approved therapies that can extend patients' life expectancy and improve quality of life. Primary care physicians (PCPs) are often involved in the process of diagnosis and follow-up of MDS patients, especially those in low-risk groups. They can therefore play an important role in improving patient care and quality of life by ensuring early referral and participating in supportive management. There is also a shortage of oncologists which increases the importance of the role of PCPs in management of MDS patients. In the face of limited resources, PCPs can improve access and quality of care in MDS patients. This article provides an overview of the common manifestations, diagnostic approaches, and therapeutic modalities of MDS for PCPs, with a focus on when to suspect MDS, when a referral is appropriate, and how to provide appropriate supportive care for patients diagnosed with MDS.
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Affiliation(s)
- Djamshed Samiev
- Department of Internal Medicine, Capital Health Regional Medical Center, Trenton, NJ, USA
| | - Vijaya R Bhatt
- Division of Hematology and Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, USA
| | - Joel D Armitage
- Division of General Internal Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, USA
| | - Lori J Maness
- Division of Hematology and Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, USA
| | - Mojtaba Akhtari
- Division of Hematology and Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, USA
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Evaluation of epidemiological factors in survival of patients with de novo myelodysplastic syndromes. Cancer Causes Control 2014; 25:425-35. [PMID: 24463789 DOI: 10.1007/s10552-014-0345-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 01/15/2014] [Indexed: 02/03/2023]
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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Özcan MA, Ilhan O, Ozcebe OI, Nalcaci M, Gülbas Z. Review of therapeutic options and the management of patients with myelodysplastic syndromes. Expert Rev Hematol 2013; 6:165-89. [PMID: 23547866 DOI: 10.1586/ehm.13.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Myelodysplastic syndromes (MDS) are a poorly understood group of disorders caused by one or more genetic aberrations in the bone marrow-derived cell line responsible for hematopoiesis. Recent advances in genetic medicine have offered new insights into the epigenesis as well as the prognosis of MDS, but have not resulted in new or improved curative treatment options. Bone marrow transplantation, introduced before the advent of genetic medicine, is still the only potential cure. Advances in other medical and pharmaceutical areas have broadened the scope of supportive care and disease-modifying therapies, and treating physicians now have a broad range of disease management options depending on a patient's likely prognosis. There is now clear evidence that appropriate supportive care and therapeutic intervention can improve progression-free and overall survival of MDS patients.
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Affiliation(s)
- Mehmet A Özcan
- Department of Hematology, Dokuz Eylül University, Izmir, Turkey.
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Otrock ZK, Tiu RV, Maciejewski JP, Sekeres MA. The need for additional genetic markers for myelodysplastic syndrome stratification: what does the future hold for prognostication? Expert Rev Hematol 2013; 6:59-68. [PMID: 23373781 DOI: 10.1586/ehm.12.67] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Myelodysplastic syndromes (MDS) constitute a heterogeneous group of clonal hematopoietic disorders. Metaphase cytogenetics has been the gold standard for genetic testing in MDS, but it detects clonal cytogenetic abnormalities in only 50% of cases. New karyotyping tests include FISH, array-based comparative genomic hybridization and single-nucleotide polymorphism arrays. These techniques have increased the detected genetic abnormalities in MDS, many of which confer prognostic significance to overall and leukemia-free survival. This has eventually increased our understanding of MDS genetics. With the help of new technologies, we anticipate that the existing prognostic scoring systems will incorporate mutational data into their parameters. This review discusses the progress in MDS diagnosis through the use of array-based technologies. The authors also discuss the recently investigated genetic mutations in MDS and revisit the MDS classification and prognostic scoring systems.
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Affiliation(s)
- Zaher K Otrock
- Leukemia Program, Cleveland Clinic Taussig Cancer Institute, OH 44195, USA
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Tong H, Hu C, Yin X, Yu M, Yang J, Jin J. A Meta-Analysis of the Relationship between Cigarette Smoking and Incidence of Myelodysplastic Syndromes. PLoS One 2013; 8:e67537. [PMID: 23805315 PMCID: PMC3689714 DOI: 10.1371/journal.pone.0067537] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 05/19/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In recent years, epidemiologic studies have reported controversial results relating cigarette smoking to myelodysplastic syndromes (MDS) risk. A meta-analysis was performed to assess such potential relationship between cigarette smoking and incidence of MDS. METHODS A search of literature published before October 2012 for observational studies evaluating the association between cigarette smoking and MDS, returned 123 articles and of these, 14 were selected for this study. The outcomes from these studies were calculated and reported as odds ratios (OR). Quality assessments were performed with the Newcastle-Ottawa Scale. Heterogeneity was evaluated by the I(2) index and source of heterogeneity was detected by sensitivity analyses. Finally, publication bias was assessed through visual inspection of funnel plots and Egger's test. RESULTS The pooled OR of developing MDS in ever-smokers was 1.45 (95% CI, 1.25 to 1.68) versus non-smokers. Current and former smokers had increased risks of MDS, with ORs of 1.81 (95% CI, 1.24 to 2.66) and 1.67 (95% CI, 1.42 to 1.96), respectively. In subset analyses, ever-smokers had increased risks of developing MDS if they were living in the United States, or in Europe, female in gender, had refractory anemia (RA)/RA with ringed sideroblasts (RARS) or RA with excess blasts (RAEB)/RAEB in transformation (RAEBt), respectively. Our results demonstrated that the association was stronger in individuals who smoked ≥20 cigarettes/day (OR, 1.62; 95% CI, 1.03 to 2.55) versus those who smoked <20 cigarettes/day (OR, 1.36; 95% CI, 1.13 to 1.64). Moreover, individuals who smoked more than 20 pack-years had increased MDS risk (OR, 1.94; 95% CI, 1.29 to 2.92). CONCLUSION Our outcomes show that smoking increases the risk of developing MDS in ever-smokers who are current or former smokers. We also demonstrate here that positive association between cigarette smoking and risk of MDS exists, and occurs in a dose-dependent manner.
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Affiliation(s)
- Hongyan Tong
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Chao Hu
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xiufeng Yin
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Mengxia Yu
- Department of Hematology, The First Affiliated Hospital of Ningbo University, Ningbo, People's Republic of China
| | - Jun Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China
- Institute of Hematology, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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What's all the fuss about? facts and figures about bone marrow failure and conditions. Curr Hematol Malig Rep 2013; 7:300-9. [PMID: 22936422 DOI: 10.1007/s11899-012-0134-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The epidemiology of bone marrow failure conditions is not well understood. Although several population-based studies conducted in the last two decades have generated a wealth of information, it is still very challenging to interpret disease incidence and prevalence, particularly due to changes in disease classification, misdiagnosis of patients, frequent underreporting and use of different referent populations to calculate rates. Despite these limitations, the available epidemiologic data have revealed significant ethnic, geographic and clinical differences in disease biology that have implications for prevention and treatment strategies. With advances made in targeted therapies facilitated by identification of molecular biomarkers and increased use of curative bone marrow transplantation approach, the natural history of these disease entities is already changing. The epidemiology of these diseases seems to be the next frontier as knowledge gained about the risk factors and pathobiologic correlates could significantly help in designing patient-specific therapies with improved outcomes.
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Bejar R, Tiu RV, Sekeres MA, Komrokji RS. Myelodysplastic syndromes: recent advancements in risk stratification and unmet therapeutic challenges. Am Soc Clin Oncol Educ Book 2013:0011300256. [PMID: 23714517 DOI: 10.14694/edbook_am.2013.33.e256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Significant advances have been achieved in understanding and treating myelodysplastic syndromes (MDS) in the past decade. For the first time, three drugs were approved specifically for this disease. Novel sequencing techniques have expanded our understanding of the molecular basis of MDS. Several clinically significant recurrent gene mutations have been identified. The classification and risk stratification of MDS continues to evolve in light of such advances. However, treatment options remain limited and novel therapeutic strategies are needed. In this review we address key questions for management of MDS. How do we better classify and risk stratify MDS, tailoring treatment accordingly? How do we diagnose and manage the challenging group of patients with MDS/myeloproliferative neoplasms (MPN) overlap? And finally, what is on the horizon for novel therapies?
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Affiliation(s)
- Rafael Bejar
- From the Division of Hematology and Oncology, Moores Cancer Center, University of California, San Diego; Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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Kroll ME, Murphy F, Pirie K, Reeves GK, Green J, Beral V. Alcohol drinking, tobacco smoking and subtypes of haematological malignancy in the UK Million Women Study. Br J Cancer 2012; 107:879-87. [PMID: 22878373 PMCID: PMC3425977 DOI: 10.1038/bjc.2012.333] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 06/21/2012] [Accepted: 06/24/2012] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Previous research suggests associations of lower alcohol intake and higher tobacco consumption with increased risks of haematological malignancy. The prospective Million Women Study provides sufficient power for reliable estimates of subtype-specific associations in women. METHODS Approximately 1.3 million middle-aged women were recruited in the United Kingdom during 1996-2001 and followed for death, emigration and cancer registration until 2009 (mean 10.3 years per woman); potential risk factors were assessed by questionnaire. Adjusted relative risks were estimated by Cox regression. RESULTS During follow-up, 9162 incident cases of haematological malignancy were recorded, including 7047 lymphoid and 2072 myeloid cancers. Among predominantly moderate alcohol drinkers, higher intake was associated with lower risk of lymphoid malignancies, in particular diffuse large B-cell lymphoma (relative risk 0.85 per 10 g alcohol per day (95% confidence interval 0.75-0.96)), follicular lymphoma (0.86 (0.76-0.98)) and plasma cell neoplasms (0.86 (0.77-0.96)). Among never- and current smokers, higher cigarette consumption was associated with increased risk of Hodgkin lymphoma (1.45 per 10 cigarettes per day (1.22-1.72)), mature T-cell malignancies (1.38 (1.10-1.73)) and myeloproliferative/myelodysplastic disease (1.42 (1.31-1.55)). CONCLUSION These findings confirm and extend existing evidence for associations of subtypes of haematological malignancy with two common exposures in women.
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Affiliation(s)
- M E Kroll
- Cancer Epidemiology Unit, Nuffield Department of Medicine, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK.
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