TY - JOUR
T1 - Risk of solid cancer, cardiovascular disease, anaphylaxis, osteoporosis and fractures in patients with systemic mastocytosis
T2 - A nationwide population-based study
AU - Broesby-Olsen, Sigurd
AU - Farkas, Dóra Körmendiné
AU - Vestergaard, Hanne
AU - Hermann, Anne Pernille
AU - Møller, Michael Boe
AU - Mørtz, Charlotte G
AU - Kristensen, Thomas Kielsgaard
AU - Bindslev-Jensen, Carsten
AU - Sørensen, Henrik Toft
AU - Frederiksen, Henrik
N1 - © 2016 Wiley Periodicals, Inc.
PY - 2016/11
Y1 - 2016/11
N2 - In patients with systemic mastocytosis (SM), several aspects of morbidity remain poorly understood. We assessed the risk of solid cancers, cardiovascular disease, anaphylaxis, osteoporosis, and fractures in SM patients. Using Danish medical registries, we conducted a nationwide population-based cohort study including 687 adult (≥15 years) SM patients diagnosed during 1997–2012. A comparison cohort of 68,700 subjects from the general Danish population who were alive and without SM at the given SM subject's diagnosis were age- and gender-matched. Outcomes were a new diagnosis of solid cancer, venous thromboembolism (VTE), myocardial infarction (MI), stroke, anaphylaxis, osteoporosis, or fracture. For solid cancers the hazard ratio (HR) was 2.4 (95% confidence interval [CI] 1.9–2.8) with a 10-year absolute risk (AR) in the SM-cohort of 12.6% (95% CI 9.4–16.3). Specifically, we found a HR of 7.5 (95% CI 4.4–13.0) for melanoma and a HR of 2.5 (95% CI 1.7–3.5) for non-melanoma skin cancers (NMSCs). For VTE we found a HR of 1.9 (95% CI 1.2–3.0), with a 10-year AR of 3.9% (95% CI 2.3–6.1); for MI a nonsignificant increased HR of 1.4 (95% CI 0.9–2.3), with a 10-year AR of 1.8% (95% CI 0.9–3.2); and for stroke a HR of 1.6 (95% CI 1.1–2.3) with a 10-year AR of 4.6% (95% CI 2.8–6.9). The HR for anaphylaxis was 7.2 (95% CI 5.3–9.9), and the 10-year AR was 3.1% (95% CI 1.9–4.9). For osteoporosis the HR was 3.6 (95% CI 2.7–4.6) with a 10-year AR of 7.2% (95% CI 5.2–9.8). For fractures the HR was 1.2 (95% CI 0.9–1.6) and the 10-year AR was 5.9% (95% CI 3.9–8.4). SM patients are at increased risk of solid cancers – especially melanoma and NMSC—and cardiovascular disease. The risk of anaphylaxis and osteoporosis is clearly increased in SM, though absolute risk was low in this population-based study. The fracture-risk was only slightly increased. Am. J. Hematol. 91:1069–1075, 2016.
AB - In patients with systemic mastocytosis (SM), several aspects of morbidity remain poorly understood. We assessed the risk of solid cancers, cardiovascular disease, anaphylaxis, osteoporosis, and fractures in SM patients. Using Danish medical registries, we conducted a nationwide population-based cohort study including 687 adult (≥15 years) SM patients diagnosed during 1997–2012. A comparison cohort of 68,700 subjects from the general Danish population who were alive and without SM at the given SM subject's diagnosis were age- and gender-matched. Outcomes were a new diagnosis of solid cancer, venous thromboembolism (VTE), myocardial infarction (MI), stroke, anaphylaxis, osteoporosis, or fracture. For solid cancers the hazard ratio (HR) was 2.4 (95% confidence interval [CI] 1.9–2.8) with a 10-year absolute risk (AR) in the SM-cohort of 12.6% (95% CI 9.4–16.3). Specifically, we found a HR of 7.5 (95% CI 4.4–13.0) for melanoma and a HR of 2.5 (95% CI 1.7–3.5) for non-melanoma skin cancers (NMSCs). For VTE we found a HR of 1.9 (95% CI 1.2–3.0), with a 10-year AR of 3.9% (95% CI 2.3–6.1); for MI a nonsignificant increased HR of 1.4 (95% CI 0.9–2.3), with a 10-year AR of 1.8% (95% CI 0.9–3.2); and for stroke a HR of 1.6 (95% CI 1.1–2.3) with a 10-year AR of 4.6% (95% CI 2.8–6.9). The HR for anaphylaxis was 7.2 (95% CI 5.3–9.9), and the 10-year AR was 3.1% (95% CI 1.9–4.9). For osteoporosis the HR was 3.6 (95% CI 2.7–4.6) with a 10-year AR of 7.2% (95% CI 5.2–9.8). For fractures the HR was 1.2 (95% CI 0.9–1.6) and the 10-year AR was 5.9% (95% CI 3.9–8.4). SM patients are at increased risk of solid cancers – especially melanoma and NMSC—and cardiovascular disease. The risk of anaphylaxis and osteoporosis is clearly increased in SM, though absolute risk was low in this population-based study. The fracture-risk was only slightly increased. Am. J. Hematol. 91:1069–1075, 2016.
KW - Adolescent
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Anaphylaxis/etiology
KW - Cardiovascular Diseases/etiology
KW - Cohort Studies
KW - Fractures, Bone/etiology
KW - Humans
KW - Mastocytosis, Systemic/complications
KW - Middle Aged
KW - Neoplasms/etiology
KW - Netherlands/epidemiology
KW - Osteoporosis/etiology
KW - Proportional Hazards Models
KW - Registries
KW - Risk Assessment
KW - Young Adult
U2 - 10.1002/ajh.24490
DO - 10.1002/ajh.24490
M3 - Journal article
C2 - 27428296
SN - 0361-8609
VL - 91
SP - 1069
EP - 1075
JO - American Journal of Hematology
JF - American Journal of Hematology
IS - 11
ER -