Income, education and their impact on treatments and survival in patients with myelodysplastic syndromes

Unveiling sex-based geographical disparities in myelodysplastic syndrome mortality trends in Spain (1999-2022)

AIM

To comprehensively analyze trends in myelodysplastic neoplasm (MDS) mortality across Spain (1999-2022), examining sex and regional differences.

METHODS

We analyzed nationwide death records and population data, calculating age-standardized mortality rates (ASMRs) and standardized mortality ratios (SMRs) stratified by sex and Autonomous Community (AC). Joinpoint regression identified significant shifts in trends.

RESULTS

Across Spain, MDS mortality risk varied among men, with rates ranging from 1.08 to 4.38 per 100,000 across regions, while women's rates ranged from 1.23 to 2.02. Five regions had higher risks than the national average, while six had lower risks. Joinpoint analysis revealed three periods nationally: a decline until 2008, and an increase until 2017, followed by a significant decrease. Despite the overall stable national trend (-0.5% annual change), significant regional variations emerged. Andalusia stood out with a worrying increase in MDS mortality, while Aragon and Murcia demonstrated promising declines. Extremadura displayed a unique trajectory with an initial rise followed by stabilization, while Galicia exhibited a contrasting trend with an initial decline and subsequent increase. Notably, men consistently faced a higher risk of MDS mortality compared to women, with significant disparities across regions. Extremadura, in particular, showed a marked difference in risk between genders.

CONCLUSION

MDS mortality trends in Spain are complex, and influenced by gender, region, and time. Further research is needed to understand regional disparities, recent national decline, and higher risk in specific demographics. Tailored interventions based on local factors and targeted research are crucial to address these complexities and improve patient outcomes.

10-year nationwide trends in incidence, treatment patterns, and mortality of patients with myelodysplastic syndromes in Denmark

Further temporal data on incidence, treatment patterns, and prognosis for patients with myelodysplastic syndromes (MDS) are needed. This study examined 10-year trends in incidence, treatment patterns, and all-cause mortality in a population-based cohort of 2309 MDS patients using Danish nationwide registries (2010-2019). We computed annual incidence rates overall and according to sex and age-groups. We examined temporal changes in the cumulative incidence of MDS specific treatments initiated within one year from diagnosis and temporal changes in the absolute risk of death and five-year adjusted hazard ratios (aHRs) for death, adjusting for age, sex and comorbidity. The age-standardized incidence rate of MDS per 100,000 person-years increased slightly from 5.3 in 2010 to 6.4 in 2019. Between 2010-2012 to 2016-2017, the use of azacitidine increased overall (8% to 22%), in patients with intermediate risk MDS (12% to 34%), and in patients with high-risk MDS (22% to 50%), while it remained stable (around 5%) for patients with low-risk MDS. The five-year aHR for death in the most recent calendar period compared to the earliest calendar period remained unchanged in patients with low-risk MDS, aHR = 0.90 (95% CI, 0.72-1.12) and in patients with high-risk MDS, aHR = 1.19 (95% CI, 0.89-1.61), while survival improved over time among patients with intermediate risk MDS, aHR = 0.67 (95% CI, 0.48-0.92). In conclusion the incidence of MDS slightly increased during a 10-year period in Denmark. The use of azacitidine increased markedly but five-year overall survival remained unchanged.

Socioeconomic position and clinical outcomes in patients with myelodysplastic syndromes: A population-based cohort study

Low socioeconomic position (SEP) may be associated with adverse outcomes in patients with myelodysplastic syndromes (MDS) inherent to for example, delayed diagnosis or reduced treatment intensity, but firm evidence is limited. In this study, we examined the association between SEP and clinical outcomes. We conducted a population-based cohort study (2010-2018) of 2233 Danish patients with MDS. SEP measures included individual-level information on education, cohabitation status and income retrieved from Statistics Denmark. Associations between SEP measures and disease severity at diagnosis were examined using binomial regression analysis. Using time-to-event analysis, we examined the association between SEP measures and treatment with allogeneic stem cell transplantation (allo-HSCT), risk of progression to acute myeloid leukemia (AML), and death. Estimates were adjusted for covariates selected based on direct acyclic graphs and reported with 95% confidence intervals. Patients with a short education were more likely to be transfusion-dependent at diagnosis (RR = 1.25, 95% CI: 1.04-1.45) and more likely to be diagnosed with higher risk MDS according to the International Prognostic Scoring System (RR = 1.29, 95% CI: 1.03-1.62), than patients with a long education. We found no clear association between SEP and risk of progression to AML. In adjusted models, the 1-year risk of dying was higher in patients with short versus long education (RR = 1.34, 95% CI: 1.08-1.65), in patients with low versus high income (RR = 1.42, 95% CI: 1.14-1.77), and among patients who lived alone compared to those who lived with a partner (RR = 1.15, 0.98-1.35). These associations persisted after 3 years and 5 years of follow-up. Notably, patients with a short education had a markedly lower rate of undergoing treatment with allo-HSCT compared to patients with a long education (HR = 0.51, 95% CI: 0.31-0.84). In conclusion, low SEP and especially short education, were poor prognostic factors for adverse clinical outcomes among patients with MDS.

The Circular RNA Circ-ANAPC7 as a Biomarker for the Risk Stratification of Myelodysplastic Syndrome

To assess the diagnostic value of circ-ANAPC7 expression levels in MDS and its risk stratification. This is a retrospective observational study. This study enrolled 125 patients diagnosed with MDS and divided them into five groups according to IPSS-R (very high group, 25; high group, 25; intermediate group, 25; low group, 25; and very low group, 25), and 25 patients with IDA were studied as control group from our bone marrow cell bank. Bone marrow cell were used as material in this study to measure the expression level of circ-ANAPC7 by qRT-PCR. An evaluation of diagnostic value was conducted using ROC curves. Circ-ANAPC7 expression levels were 5.623 ± 4.483, 28.396 ± 12.938, 91.867 ± 37.010, 202.525 ± 54.911, 337.633 ± 86.013, and 502.269 ± 98.410 from the control group to the very high group, respectively (p < 0.05). Circ-ANAPC7 expression was gradually upregulated with the risk stratification of MDS. The AUCs of circ-ANAPC7 were 0.973, 0.996, 0.951, 0.920, and 0.907 in the control group/very low group, very low group/low group, low group/intermediate group, intermediate group/high group, and high group/very high group, respectively. In this study, the expression level of circ-ANAPC7 was found to be a promising biomarker for MDS. It may be added to the scoring system to better identify risk groups.