Therapy-related MDS dissected based on primary disease and treatment-a nationwide perspective

Abstract

In this population-based study, we aimed to characterize and compare subgroups of therapy-related Myelodysplastic syndromes (t-MDS) and define the implications of type of previous treatment and primary disease. We combined data from MDS patients, diagnosed between 2009 and 2017 (n = 2705), in the nationwide Swedish MDS register, with several health registers. Furthermore, using matched population controls, we investigated the prevalence of antecedent malignancies in MDS patients in comparison with the general population. This first ever nationwide study on t-MDS confirms a shorter median survival for t-MDS compared to de novo MDS (15.8 months vs 31.1 months, p < 0.001). T-MDS patients previously treated with radiation only had disease characteristics with a striking resemblance to de novo-MDS, in sharp contrast to patients treated with chemotherapy who had a significantly higher risk profile. IPSS-R and the WHO classification differentiated t-MDS into different risk groups. As compared with controls, MDS patients had a six-fold increased prevalence of a previous hematological malignancy but only a 34% increased prevalence of a previous solid tumor. T-MDS patients with a previous hematological malignancy had a dismal prognosis, due both to mortality related to their primary disease and to high-risk MDS.

Fig. 1. OS of de novo-MDS and subgroups of t-MDS.

a OS by different treatments for the primary disease. b OS by type of primary disease.

Fig. 2. OS by IPSS-R risk group.

a OS of patients with de novo-MDS. b OS of all patients with t-MDS. c OS of patients with t-MDS treated with chemotherapy only. d OS of patients with t-MDS treated with radiation only. e OS of patients with t-MDS treated with chemotherapy in combination with radiation. f OS of patients with t-MDS with a solid tumor as a primary disease. g OS of patients with t-MDS with a hematological malignancy as a primary disease. h OS of patients with t-MDS with a non-malignant disease as a primary disease.

Fig. 3. OS by WHO risk group.

a OS of patients with de novo-MDS. b OS of all patients with t-MDS. c OS of patients with t-MDS treated with chemotherapy only. d OS of patients with t-MDS treated with radiation only. e OS of patients with t-MDS treated with chemotherapy in combination with radiation. f OS of patients with t-MDS with a solid tumor as a primary disease. g OS of patients with t-MDS with a hematological malignancy as a primary disease. h OS of patients with t-MDS with a non-malignant disease as a primary disease.

Fig. 4

Multivariate analyses of the all-cause mortality of t-MDS patients by patient and disease characteristics.