Venous thromboembolism during systemic inflammatory and autoimmune diseases associated with myelodysplastic syndromes, chronic myelomonocytic leukaemia and myelodysplastic/myeloproliferative neoplasms: a French multicentre retrospective case-control study

Marie Péan de Ponfilly-Sotier (1) , Vincent Jachiet (1) , Ygal Benhamou (2) , Constance Lahuna (1) , Benoit de Renzis , Diane Kottler , Laurent Voillat , Sophie Dimicoli-Salazar , Anne Banos , Marie-Paule Chauveheid , Jean-François Alexandra , Eric Grignano , François Liferman , Mathilde Laborde , Jonathan Broner , Marc Michel , Olivier Lambotte , Kamel Laribi , Marie-Dominique Venon , Bertrand Dussol , Nihal Martis , Sylvain Thepot , Sophie Park , David Couret , Marielle Roux-Sauvat , Louis Terriou (3) , Eric Hachulla (3) , Cécile Bally , Joris Galland , Jean-Sébastien Allain (4, 5) , Anne Parcelier , Pierre Peterlin , Judith Cohen-Bittan , Alexis Regent , Felix Ackermann , Julien Le Guen , Caroline Algrin , Pierre Charles , Etienne Daguindau , Xavier Puechal , Bertrand Dunogue , Claire Blanchard-Delaunay , Odile Beyne-Rauzy , Vincent Grobost , Jean Schmidt , Thomas Le Gallou , Georgeta Dubos-Lascu , Anne Sonet , Guillaume Denis , Frédérique Roy-Peaud , Pierre Fenaux , Lionel Adès , Olivier Fain (1) , Arsène Mekinian (1)

1 CHU Saint-Antoine [AP-HP]
2 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
3 INFINITE (Ex-Liric) - Institute for Translational Research in Inflammation - U 1286
4 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
5 CIC - Centre d'Investigation Clinique [Rennes]

Objectives: Myelodysplastic syndromes (MDS) and chronic myelomonocytic leukaemia (CMML) are associated with systemic inflammatory and autoimmune diseases (SIADs) in 10-30% of cases. The aims of this study were (i) to evaluate the prevalence of venous thromboembolism VTE in patients presenting with both MDS/CMML and SIADs, (ii) to describe risk factors associated with thrombosis, and (iii) to analyse the impact of VTE on overall survival and transformation to acute myeloid leukaemia in comparison to patients with MDS/CMML-associated SIADs without VTE.Methods: This retrospective multicentre case-control study was conducted among patients with MDS/CMML and dysimmune disorders and featured in the French retrospective database of the French Network of Dysimmune Disorders Associated with Hemopathies (MINHEMON), diagnosed with MDS/CMML and dysimmune disorders.Results: During a median follow-up of 16 months (5-48) VTE occurred in 35 patients (21.6 %) whereas 127 patients did not. Among those with VTE, 8 patients (22.9%) experienced two or more VTE. Common prothrombotic risk factors were not significantly different in patients with or without VTE. CMML was more frequent in patients without VTE (37 % vs. 14.3%, p=0.01), whereas myelodysplasic/myeloproliferative neoplasm (MDS/MPN) was higher in VTE patients (20 % vs. 5.5 %, p=0.01). In a multivariate analysis, only MDS/CMML progression at the time of VTE (odds ratio 28.82, 95 % CI (5.52-530.70) was significantly associated with VTE. When treated with an anticoagulation therapy, bleeding occurred in 19.4% of cases (6/31). Overall survival was not significantly different between patients with and without VTE (p=0.68). Leukaemia-free survival between groups was not significantly different (p=0.83).Conclusions: VTE is a common complication in MDS/CMML-associated SIADSs with an increased risk of bleeding when treated by anticoagulants. In the MDS/CMML subgroup, SIADS flares and MDS/CMML progression seem to be prothrombotic risk factors.

Domaines: Sciences du Vivant [q-bio]

Marie Péan de Ponfilly-Sotier, Vincent Jachiet, Ygal Benhamou, Constance Lahuna, Benoit de Renzis, et al.. Venous thromboembolism during systemic inflammatory and autoimmune diseases associated with myelodysplastic syndromes, chronic myelomonocytic leukaemia and myelodysplastic/myeloproliferative neoplasms: a French multicentre retrospective case-control study. Clinical and experimental rheumatology, 2022, 40 (7), pp.1336-1342. ⟨10.55563/clinexprheumatol/nbn38d⟩. ⟨hal-03968172⟩