Chronic Immune Stimulation Might Act As a Trigger for the Development of Acute Myeloid Leukemia or Myelodysplastic Syndromes
Chronic Immune Stimulation Might Act As a Trigger for the Development of Acute Myeloid Leukemia or Myelodysplastic Syndromes
复制标题
DOI：
10.1200/jco.2011.34.8540
复制
发表时间：
2011-07-20
影响因子：
45.3
通讯作者：
Goldin, Lynn R.
中科院分区：
文献类型：
--
作者：
Kristinsson, Sigurdur Y.;Bjorkholm, Magnus;Goldin, Lynn R.
目的急性髓细胞白血病（AML）和骨髓增生异常综合征（MDS）患者常伴有感染，但很少有资料能评估个人感染史是否是致病的诱因。为了进一步扩大我们对免疫刺激在AML和MDS病因中的作用的认识，我们进行了一项大型的基于人群的研究，以评估与广泛的感染或自身免疫性疾病的既往史相关的AML和MDS的风险。和42,878个匹配的对照组。我们使用Logistic回归计算比值比（OR）和95%CI的AML或MDS与感染性和/或自身免疫性疾病的关联。ResultsOverall，任何感染性疾病的历史与AML（OR，1.3; 95%CI，1.2至1.4）和MDS（OR，1.3; 95%CI，1.1至1.5）的风险显着增加。即使我们将感染限制在AML/MDS发生前3年或更长时间，这些相关性也是显著的。任何自身免疫性疾病的既往病史与AML风险增加1.7倍（95% CI，1.5至1.9）和MDS风险增加2.1倍（95% CI，1.7至2.6）相关。一个大范围的条件是每个显着相关的AML和MDS.ConclusionOur新的研究结果表明，慢性免疫刺激作为AML/MDS发展的触发器。潜在的机制也可能是由于常见的遗传易感性或感染/自身免疫性疾病的治疗效果。J Clin Oncol 29：2897-2903. (C)2011年美国临床肿瘤学会
PurposePatients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) often present with infections, but there are little data to assess whether a personal history of selected infections may act as pathogenic triggers. To additionally expand our knowledge on the role of immune stimulation in the causation of AML and MDS, we have conducted a large, population-based study to evaluate the risk of AML and MDS associated with a prior history of a broad range of infections or autoimmune diseases.Patients and MethodsBy using population-based central registries in Sweden, we included 9,219 patients with AML, 1,662 patients with MDS, and 42,878 matched controls. We used logistic regression to calculate odds ratios (ORs) and 95% CIs for the association of AML or MDS with infectious and/or autoimmune diseases.ResultsOverall, a history of any infectious disease was associated with a significantly increased risk of both AML (OR, 1.3; 95% CI, 1.2 to 1.4) and MDS (OR, 1.3; 95% CI, 1.1 to 1.5). These associations were significant even when we limited infections to those occurring 3 or more years before AML/MDS. A previous history of any autoimmune disease was associated with a 1.7-fold (95% CI, 1.5 to 1.9) increased risk for AML and 2.1-fold (95% CI, 1.7 to 2.6) increased risk for MDS. A large range of conditions were each significantly associated with AML and MDS.ConclusionOur novel findings indicate that chronic immune stimulation acts as a trigger for AML/MDS development. The underlying mechanisms may also be due to a common genetic predisposition or an effect of treatment for infections/autoimmune conditions. J Clin Oncol 29:2897-2903. (C) 2011 by American Society of Clinical Oncology