Study suggests ‘significant’ link between sickle cell trait, leukemia
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Key takeaways:
- Patients with myeloid and monocytic leukemia are at increased risk for leukemia.
- Future prospective studies are needed to further understand the relationship and more specific risk factors.
SAN DIEGO — Individuals with sickle cell trait are at increased risk for leukemia, specifically myeloid and monocytic leukemias, according to data presented at ASH Annual Meeting and Exposition.
However, prospective studies in the future that analyze mapping of specific risk factors and additional data can help better understand the potential relationship, according to researchers.
“Sickle cell trait, although a benign condition, is associated with an increased risk for leukemia,” Mehndi Dandwani, MBBS, a hospice and palliative medicine fellow at the University of Iowa Health Care, said in a presentation.
“Our study showed a statistically significant association [with] myeloid and monocytic leukemias rather than lymphoid leukemias,” she added. “This can be postulated to the shared myeloid progenitor lineage with erythrocytes.”
Background and methodology
Researchers conducted a case-control study to evaluate the potential association between sickle cell trait and leukemia and its subtypes in a nationwide cohort of hospitalized patients included in the National Inpatient Sample 2016-2019 database.
Inclusion criteria for study cases included patients with lymphoid leukemia, myeloid leukemia, monocytic leukemia, leukemia of specified cell type and leukemia of an unspecified cell type, while exclusion criteria included Down syndrome, Fanconi anemia, ataxia-telangiectasia, Bloom syndrome, myelodysplastic syndrome, lymphoma and solid malignancies due to their known risk for leukemia independent of sickle cell trait, according to researchers.
Patients identified as control subjects included individuals in the National Inpatient Sample database who did not have any of the aforementioned leukemia diagnoses and met the exclusion criteria applied to the study cases.
Researchers utilized a 1:4 propensity score matching routine for each year. Match variables included sex, the six race categories used by the National Inpatient Database and 11 age groups.
The study included 181,676 individuals identified as ‘cases’ and 726,704 identified as ‘controls,’ with a mean age of 59 years (56% male).
Results, next steps
Researchers observed a greater proportion of patients with sickle cell trait to have leukemia than those in the control group (0.12% vs 0.08%), as persons with sickle cell trait are almost 50% more likely to have any form of leukemia (OR = 1.48; 95% CI, 1.27 – 1.73), according to the study findings.
Upon analysis of relationships between sickle cell trait and leukemia subtypes, associations between myeloid (OR = 1.74; 95% CI, 1.40 – 2.17) and monocytic leukemias (OR = 2.20; 95% CI, 1.09 – 4.42) appeared most statistically significant.
Overall, data shows statically significance of higher odds of sickle cell trait among patients with any form of leukemia as compared to controls, indicating that such can increase leukemia risk.
Dandwani identified study limitations, including the use of inpatient data that excludes the wider population with sickle cell trait and the possibility for coding errors.
“Future prospective studies are needed for mapping individual risk factors and to look at the percentage of hemoglobin 5 (HbS) in [sickle cell trait] carriers who may be susceptible to developing leukemia,” Dandwani said.
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Sostin O, et al. Abstract 148. Presented at: ASH Annual Meeting and Exhibition; Dec. 5-9, 2023; San Diego.
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