Introduction Myelodysplastic syndrome (MDS) is a heterogeneous clonal disorder of hematopoietic stem cells characterized by dysplasia and restricted maturation resulting in ineffective hematopoiesis and peripheral blood cytopenias. Refractory anemia with excess blasts (RAEB) is a subtype of MDS, defined by the presence of 2%-19% blasts in peripheral blood or 5%-19% blasts in the bone marrow. The purpose of this study is to determine the racial and gender disparities and survival trends in patients with RAEB.

Methods We collected RAEB cases from Surveillance, Epidemiology and End Result database Research Plus Data, 17 Registries, Nov 2024 Sub (2000-2022), using the ICD Code 9983/3. The analysis was further stratified based on age, sex, race, year of diagnosis, income, demography and treatment with chemotherapy and radiation therapy. Survival curves were then compared using the Log-Rank test (GraphPad Prism).

Results We extracted 12155 cases of refractory anemia with excess blasts. The median age of diagnosis was 74 years. 60.7% of the cases were males, while only 39.3% were females. The neoplasm was most noted in Caucasians (77.1%) and then Hispanics (8.4%), Asians/Pacific Islanders (7.2%), Black (6.6%) and Alaskans/American Indians and unknown race <1% each.

Overall median of survival (MoS) was 11 months, with a 1-year OS of 47.4% (CI 95%, 46.5-48.3), 3-year OS of 18.1% (CI 95%, 17.4-18.8), and 5-year OS of 10.97% (CI 95%, 10.4-11.6). MoS were significant for Age: 0-65 years (16 months), 65+ years (10 months) (p <0.0001); Race: Caucasians (11 months), Black (11 months), Hispanics (12 months), Asian/Pacific Islanders (13 months), Alaskan/Native Americans (15 months) (p <0.0001); Income: less than 40,000$ - 70,000$ (10 months), 70K-100K (11 months), 100K+ (14 months); Demography: residents in a metropolitan area (12 months) vs non-metropolitan area (10 months) (p value 0.0003). Treatment based survival analysis showed: chemotherapy (14 months) vs no chemotherapy (8 months) (p <0.0001), XRT (27 months) vs no XRT (11 months). Survival analyses based on gender was insignificant.

Mortality-to-Incidence Ratio (MIR) trend was notable for 2000-2005 (96.6%), 2006-2011 (95.5%), 2012-2016 (92.2%), and 2017-2022 (69.3%) (p 0.0001, Logrank test for trend).

Conclusion

Refractory anemia with excess blasts is a subtype of MDS with a very high mortality. Our analysis revealed that it favors male gender, and Caucasian race. Superior survival outcomes were observed with age less than 65, Asian/Pacific Islanders or Alaskan/Native Americans origin, income above 100K and metropolitan residence. Management with chemotherapy or radiotherapy were also associated with higher survival. No significant association was noted with gender. Further research and analysis is warranted to identify specific targetable mutations to help improve overall survival in this aggressive hematologic malignancy.

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2025
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