The Burden of Cardiovascular-Related Mortality in Early-Onset Acute Myeloid Leukemia

Introduction

Acute myeloid leukemia (AML) is an aggressive hematological malignancy that is rare in individuals under 50 years old (early-onset AML) even though it constitutes approximately one-third of leukemia cases in adults. Cardiovascular-related death (CVD) remains a prevalent cause of mortality in the older population with AML. The epidemiology of CVD in individuals with early-onset AML is not well understood. This study examines the trends of CVD in early-onset AML compared to older individuals with the disease.

Method

Cases of AML diagnosed in individuals aged 15 years and older between 2000 and 2020 were extracted from the Surveillance, Epidemiology, and End Results (SEER) Research Plus Data 17 Registries. Descriptive statistics of sex and race were compared between early-onset AML (15-49 years) and adult-onset AML (diagnosed at age 50 years and older). Standardized mortality ratio (SMR), age-standardized incidence-based mortality rates (ASMR), and annual percentage change (APC) were used to compare mortality trends.

Results

A total of 70,824 patients with AML were diagnosed between 2000 and 2020. Early-onset AML accounted for 13,096 cases (18.5%). Among these, 1,966 patients (3.5%) died from cardiovascular diseases, with 129 deaths occurring in those with early-onset AML (6.6% vs. 93.4% in adult-onset AML). Among those with early-onset AML who died from CVD, the racial distribution was as follows: White individuals accounted for 72 deaths (55.8% vs. 75.2% in adult-onset AML), Black individuals - 25 deaths (19.4% vs. 8.1% in adult-onset AML), Hispanic individuals - 21 deaths (16.3% vs. 8.98% in adult-onset AML), Asian individuals - 10 deaths (7.75% vs. 7.13% in adult-onset AML), and Native Americans accounted for 1 death (0.775% vs. 0.44% in adult-onset AML).

The SMR for early-onset AML was higher compared to adult-onset AML (3.00 [2.47-3.63] vs. 2.71 [2.56-2.87]).

From 2000 to 2020, the overall ASMR in early-onset AML increased more significantly compared to adult-onset AML (APC, 4.60% [0.99 to 9.41] vs. 2.40% [1.42 to 3.54]). The increase in ASMR among early-onset AML was more pronounced in males compared to females (APC, 2.71% [1.18 to 4.26] vs. 2.07% [0.66 to 3.49]), and higher in non-Hispanic Blacks compared to non-Hispanic Whites (APC, 3.76% [1.28 to 6.30] vs. 2.85% [1.70 to 4.01]). There was no significant change among other racial groups.

Conclusion

Although AML is uncommon in individuals under 50 years old, the rate of CVD mortality is rising faster in younger AML patients compared to older individuals with the disease, who are traditionally more predisposed to cardiovascular conditions. High surveillance for the onset of cardiovascular disease should be maintained in young people with AML to address this rising issue.