Open AccessIntensive Chemotherapy Is Associated With Poor Overall Survival in Autoimmune Disease‐associated Myeloid Malignancies
Author(s) -
Richardson Simon E.,
Brian Duncan,
Grandage Victoria,
Hough Rachael,
Kottaridis Panagiotis,
Mansour Marc R.,
Payne Elspeth M.,
Khwaja Asim
Publication year - 2019
Publication title -
hemasphere
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 11
ISSN - 2572-9241
DOI - 10.1097/hs9.0000000000000164
Subject(s) - medicine , myeloid leukemia , myeloid , oncology , cyclophosphamide , cytarabine , chemotherapy , azathioprine , immunology , disease
Between 10% and 20% of cases of myelodysplastic syndrome (26%) cytogenetics and intensive treatment (including allogeneic (MDS) and acute myeloid leukemia (AML) are associated with prior exposure to cytotoxic chemotherapy or ionizing radiation. Such therapy-related myeloid neoplasms have also been associated with treatment for nonmalignant conditions, notably autoimmune diseases (AID) such as inflammatory bowel disease (IBD) and rheumatoid arthritis (RA). Furthermore, the chronic inflammatory state associated with AID has been associated with an increased risk of myeloid malignancies, independent of the treatments used. A recent study of over 40,000 patients with AID showed a statistically significant 7-fold increase in therapyrelated myeloid neoplasms in patients treated with azathioprine, with smaller, nonsignificant risks attributable to cyclophosphamide and mitoxantrone, but not anti-tumor necrosis factor therapy (in contrast with lymphoma). While therapy-related myeloid neoplasms are generally associated with poor prognosis, there are limited published outcome data in the AID setting. In a single-center experience of 23 patients with AID-associated AML, most exhibited intermediate (43%) or favorable risk