BOSTON – Certain veterans who were stationed at Camp Lejeune, NC, between Aug. 1, 1953, and Dec. 31, 1987, have a presumptive service connection to aplastic anemia and other myelodysplastic syndromes because of exposure to contaminated water.
Some new research is of special interest to clinicians who work at the highly-diverse VA and DoD and treat myelodysplastic syndrome (MDS), which is a heterogeneous group of clonal myeloid neoplasms with poor long-term outcomes compared to other cancers.
A Harvard Medical School study noted that racial/ethnic disparities in cancer incidence and survival “have been reported in many cancers and constitute major health policy and societal issues.” The report in Clinical Lymphoma, Myeloma & Leukemia noted that data from U.S. cancer registries indicate that Black patients have the highest mortality rate of any racial and ethnic group for all cancers combined, and for several cancers individually.1
On the other hand, the researchers pointed out that disparities in MDS have been poorly studied. To remedy that, the study team sought to better understand the relationship between race, on one hand, and baseline characteristics, overall survival, and cause of death in MDS in the United States, on the other.
The study used the Surveillance, Epidemiology, and End Results (SEER) registry of the National Institute of Health and included 37,562 patients – 8.1% Black and 91.9% white — with MDS diagnosed between 2001-2013.
Results indicated that Black race was associated with longer overall survival (HR: 0. 79; 95% CI: 0.76- 0.83; p<0.001). Median overall survival (mOS) was 33 months for Black and 26 months for white, according to researchers, who said the association was maintained in sensitivity analyses (multivariable and matching) adjusting for differences in baseline demographics and disease characteristics.
Further analysis by histology subset revealed variable levels of association between race and OS with MDS-NOS, a category defined in SEER, representing 52% of cases in our study with the strongest association and contributing largely to the overall result.
“Black patients had a lower mortality risk due to MDS/leukemia (IRR: 0.79; 95% CI: 0.74-0.84, p<0.001) and a higher risk for cardiovascular death (IRR: 1.12; 95% CI: 1.02-1.23; p=0.02),” the study team added.
“In this large retrospective study of MDS cases in SEER, we observed differences in patients’ demographics, socio-economic factors, disease subtype, mortality rate per COD, and survival outcomes between Black and white patients,” the authors concluded. “The finding of Black having better OS outcomes than white patients was unexpected and needs to be further researched, specifically the contribution of the poorly defined MDS-NOS subset to the overall finding.”
Another recent study in Leukemia & Lymphoma suggested, “Race and ethnic backgrounds affect the disease characteristics and clinical outcomes in many cancers, including acute myeloid leukemia; however, the association of race/ethnicity on myelodysplastic syndrome (MDS) is still controversial.”
In this study, UT Southwestern Medical Center-led researchers sought to study the impact of race/ethnicity on the disease characteristics and survival outcomes in patients with MDS.2
Included in the study were adult patients with MDS diagnosed in 2004–2016, using the SEER database. Race/ethnicity was categorized as:
- non-Hispanic White (NHW),
- non-Hispanic Black (NHB), and
“Hispanic and NHB patients had significantly lower incidence rate ratio (IRR) in age group ≥01 years (p < .001) compared to NHW; however, in the age group <50 years, NHB patients had significantly higher IRR with an increased incidence rate of 49%,’ the authors advised.
They also found that non-Hispanic Black patients had better overall survival than Hispanic and NHW patients, even after adjusting for confounding variables.
“MDS have significant differences in age at diagnosis, disease risk, and survival outcomes based on racial/ethnic backgrounds,” the researchers concluded.
- Lesegretain A, Laadem A, Fell G, Fathi AT. MDS-556 Comparison of Demographics, Disease Characteristics and Outcomes Between Black and White Patients With Myelodysplastic Syndrome: A Population-Based Study. Clin Lymphoma Myeloma Leuk. 2022 Oct;22 Suppl 2:S322. doi: 10.1016/S2152-2650(22)01429-X. PMID: 36163978.
- Goksu SY, Ozer M, Goksu BB, Wang R, Khatib J, Patel PA, Vusirikala M, Cole S, Seyhanli A, Collins RH, Chung S, Zeidan AM, Madanat YF. The impact of race and ethnicity on outcomes of patients with myelodysplastic syndromes: a population-based analysis. Leuk Lymphoma. 2022 Jul;63(7):1651-1659. doi: 10.1080/10428194.2022.2032034. Epub 2022 Feb 8. PMID: 35133215.