CVD Significantly Affects Survival in Patients with Acute Myeloid Leukemia or Myelodysplastic Syndromes

Research presented at the 62nd ASH Annual Meeting & Exposition indicates that the presence of cardiovascular disease (CVD) is a very important indicator of outcomes in patients with myelodysplastic syndromes (MDS).

The researchers retrospectively reviewed cases of 295 patients who had been diagnosed with acute myeloid leukemia (AML), MDS, or MDS/myeloproliferative neoplasm (MDS/MPN). They had a median age of 66 years at diagnosis. Of those patients, 92 patients (31%) had CVD, and 203 (69%) did not. Cardiovascular diagnoses included:

• Congestive heart failure
• Coronary artery disease
• Arrhythmia
• Peripheral vascular disease
• Congenital heart disease
• Cerebrovascular accident

The researchers compared the groups and found that the patients with CVD were older and had higher rates of:

• Hypertension
• Hyperlipidemia
• Diabetes
• Obesity

The study’s primary endpoints were overall response rate, overall survival (OS), cardiac events, and death within 60 days of the start of treatment.

Among the 228 patients with AML, complete remission (CR) was achieved in 20% of patients with CVD versus 48% of patients without. CR with incomplete count recovery was similar between the groups, as was partial remission (PR). Early death occurred in 33.3% versus 10.5%, respectively.

Among the 67 patients with MDS or MDS/MPN, 12% of patients with CVD achieved CR, as opposed to 6% of the patients with no CVD. CR with incomplete count recovery was 6% versus 0%, respectively. Furthermore, 6% as opposed to 16%, respectively, achieved hematologic improvement. PR was similar between groups. However, early death occurred in 12% versus 4%.

One-, two-, and three-year OS rates were significantly worse in patients with car CVD in both patients with AML and those with MDS/MPN, even when the researchers adjusted for age, performance status, and karyotype. Interestingly, smoking history (as measured in pack-years) did not impact OS.

At a median follow-up of 15 months, 75% of patients with CVD had died compared with 54% patients without CVD.

“As the incidence of both CVD and myeloid malignancies increases with age, a better understanding of their association and shared complications can translate into better therapeutic options,” said presenter Gabriela Sanchez-Petitto, MD, of the Division of Hematology and Oncology at the University of Maryland Greenebaum Comprehensive Cancer Center in Baltimore.