Myelodysplastic syndromes spatial clusters in disease etiology and outcome

Abstract

The myelodysplastic syndromes (MDS) are a heterogeneous group of hematopoietic disorders. This study aims to advance the use of spatial modeling in disease etiology and monitoring based on reports on a large population (n = 984) of MDS patients diagnosed in the Eastern United States. The spatial MDS clustering was analyzed using SaTScan, and patient clinical characteristics were analyzed using logistic regression and Cox hazards models adjusting for covariates. One main and five secondary spatial clusters (p-value < 10⁻¹⁷–10⁻⁷) were identified. Patients living in high vs. low MDS incidence clusters tended to be older (OR_adj = 1.04 [1.004, 1.07]) and smokers (OR_adj = 2.9 [1.1, 7.4]). Mortality was associated with hemoglobin (HR_adj = 0.7 [0.5, 0.9]), neutrophils (HR_adj = 0.7 [0.6, 0.96]), platelets (HR_adj = 0.5 [0.4, 0.7]), and blast (HR_adj = 1.4 [1.1, 1.8]), but not clusters. The results suggest large geographic variations in MDS incidence rates. The biological aggressiveness of the disease is unlikely to be associated with its spatial distribution.

Keywords::

• Clustering
• incidence
• MDS

Acknowledgements

This study was partially supported by a contract from AMGEN. We are grateful to Ms Peta-Gaye Reid for data collection and chart review. There are no actual or potential competing interests regarding the submitted material with any of the participating authors. The authors thank the reviewers for their helpful comments and suggestions to improve this paper.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/lal.

Supplementary material available online

Supplementary Figures 1–2 and Table I