Therapy-related myeloid neoplasms: A SEER database analysis of residential distribution on overall survival.

Abstract

e18605 Background: Therapy-related myeloid neoplasms (T-MN), now recognized by the WHO, have increased in incidence due to advances in cancer therapies and survivorship. With a poor prognosis (8-10 months survival), T-MN poses challenges like aggressive disease and diminished marrow reserve, while the impact of geographic factors on outcomes remains unexplored. This study investigates the effects of residential distribution, demographics, and exposure to treatment on survival outcomes in T-MN using SEER data. Methods: T-MN cases collected from the Surveillance, Epidemiology, and End Result Database Research Plus Data, 17 Registries, Nov 2023 Sub (2000-2021), using the ICD Code 9920/3. The data was filtered by deaths attributable to cancer, and then stratified based on age, gender, race, residential distribution, year of diagnosis (YOD), income adjusted to 2022, and treatments received. Survival curves were compared using the Log-Rank test (GraphPad Prism). Results: A total of 1,629 T-MN cases were identified, with 48.2% male and 51.8% female distribution. Of the patients, 85.9% lived in metropolitan areas and 14.1% in non-metropolitan areas, with median survival(MS) of 7 months (M) and 5M, respectively (p<0.05). Patients younger than 50 had higher MS (8.5M) than older than 50, (7M)(p<0.0001). Patients who received chemotherapy (Cx) had better survival(MS 8), than those that did not(MS 3)(p<0.0001). MS with prior radiotherapy (XRT) was 11 M than 6M for no prior XRT (p 0.0032). Survival improved from 2011-2021(MS 15M) compared to 2000-2010 (MS 6.5M) (p<0.0001). The racial distribution was as follows: White (76.8%), Hispanic (10%), Black (7.4%), Asian/Pacific Islander (5.4%), and American Indian/Alaskan or unknown race (<1% each). Of the total cohort, 83% reported an income below $100,000.Statistical analysis revealed no significant differences based on gender, race, or income. Conclusions: T-MN is an aggressive malignancy with a poor prognosis and rising incidence tied to increased chemotherapy and radiation use. Metropolitan residence, younger age, YOD (2011-2021), along with chemotherapy and prior XRT exposure were linked to higher survival outcomes. Improved outcome with later YOD likely due to improved diagnostic and treatment strategies; worse outcomes with non-metropolitan residents may result from a lack of equitable healthcare access. Categories Subcategories Number of Cases (t=1629) Metropolitan (1400/85.9%) Non-Metropolitan (229/14.1%) Median of Survival P-value Age 0-50 236 (14.5%) 214 (90.7%) 22 (9.3%) 8.5 <0.0001 50-70 831 (51%) 704 (84.7%) 127 (15.3%) 7 70+ 562 (34.5%) 482 (85.8%) 80 (14.2%) 5 YOD 2000-2010 324 (19.9%) 270 (83.3%) 54 (16.7%) 6.5 <0.0001 2011-2021 1305 (80.1%) 1130 (86.6%) 175 (13.4%) 15 Cx Yes 1177 (72.3%) 1011 (85.9%) 166 (14.1%) 8 <0.0001 No 452 (27.7%) 389 (86.1%) 63 (13.9%) 3 Location Metropolitan 1400 (85.9%) 7 0.0403 Non-Metropolitan 229 (14.1%) 5