Diego Adrianzen Herrera, M.D.
Autoimmune disease is frequent in patients with myelodysplastic syndromes (MDS), a group of blood disorders, but research studies have been inconclusive about how the preexistence of autoimmunity affects survival in these patients. A new study by UVM Cancer Center member Diego Adrianzen Herrera, M.D., assistant professor of medicine, uses an epidemiologic analysis to clarify this issue.
Adrianzen Herrera and colleagues’ new study published in Blood Advances, investigated the impact of preexisting autoimmune diseases on the outcomes of patients with MDS. Autoimmune diseases are conditions where the body's immune system mistakenly attacks its own tissues. These diseases are present in 10-30 percent of individuals with MDS, and previous studies have produced conflicting results about how they affect MDS patients.
To gain clarity, researchers used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to analyze MDS cases from 2007 to 2017. Their analysis involved 15,277 MDS patients, of whom 16 percent had preexisting autoimmune diseases. Using an epidemiologic analysis, investigators considered factors including demographics, comorbidity scores, MDS type, blood transfusion requirements, treatment approaches, and the impact of autoimmune diseases on both survival and the risk of developing leukemia.
The study found that having an autoimmune disease was associated with an 11 percent reduced risk of death in MDS patients, indicating potential longer overall survival for these individuals. However, the influence of autoimmune diseases may promote progression to acute myeloid leukemia in a subgroup of patients with low histologic risk. In this subgroup, having an autoimmune disease was linked to a 1.9-fold increased risk of leukemia, but this effect was not observed in other MDS groups. The use of immunosuppression for autoimmune disease did not affect the survival of these patients.
These findings suggest that autoimmune diseases have a complex impact on MDS patients. While they may improve overall survival, they might also raise the risk of progressing to leukemia in certain low-risk MDS cases. This duality implies that there could be underlying factors, such as inflammation-driven changes in blood cell formation and clonal expansion, that warrant further investigation. Further analysis will focus on molecularly exploring risk of leukemia associated with autoimmunity on low histology risk patients with myelodysplastic syndromes.
Adrianzen Herrera received the 2022 Hemostasis and Thrombosis Research Society mentored research award, which provided funding for this study.