Outcomes of Patients With Therapy-Related MDS After Chemoimmunotherapy for Chronic Lymphocytic Leukemia Compared With Patients With De Novo MDS: A Single-Institution Experience.

Background: Patients with chronic lymphocytic leukemia (CLL) treated with chemoimmunotherapy are at increased risk of developing therapy-related (t-) myelodysplastic syndrome (MDS). It is unclear whether antecedent CLL adds prognostic value to the revised International Prognostic Scoring System (IPSS-R) for MDS. We performed a retrospective analysis to evaluate the significance of a previous CLL diagnosis as an independent adverse prognostic factor.
Patients and Methods: We identified 18 consecutive patients with t-MDS, previously treated for CLL (CLL-MDS) from 2002 to 2016. For each CLL-MDS patient, we identified 2 control patients with de novo MDS matched for age (≤ 65 or > 65 years), IPSS-R (≤ 3 or > 3), and year of MDS diagnosis (before or after 2008). Multivariable models were developed to test for independent predictors of progression to acute myeloid leukemia (AML) and overall survival (OS).
Results: Median time from CLL to MDS diagnosis was 58.8 months (range, 12-280 months) and median number of treatment lines for CLL was 1 (range, 1-5), including alkylating agents in 15 patients (83%) and fludarabine, cyclophosphamide, rituximab in 12 patients (67%). Hypomethylating agents were administered in 13 (72%) of CLL-MDS patients and 33 (91%) of de novo MDS patients. After a median follow-up of 19.2 months, OS was not different between CLL-MDS and matched de novo MDS patients. CLL-MDS patients with IPSS-R score ≤ 3 had better OS compared with those with IPSS-R score > 3. In multivariate analysis, there was no significant independent association between history of CLL OS or progression to AML.
Conclusion: History of CLL did not independently affect OS in t-MDS patients beyond IPSS-R score.
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