Looking beyond VEXAS: Coexistence of undifferentiated systemic autoinflammatory disease and myelodysplastic syndrome

Semin Hematol. 2021 Oct;58(4):247-253. doi: 10.1053/j.seminhematol.2021.10.003. Epub 2021 Oct 9.

Abstract

It has been established that individuals with myelodysplastic syndromes (MDS) have a higher frequency of systemic inflammatory disorders. On the other hand, patients with autoimmune diseases are at increased risk of MDS development. Both diseases can be associated with various genetic lesions and share diverse pathogenetic mechanisms. Recently identified VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome, associated with somatic mutations in UBA1, encompasses a range of inflammatory conditions involving multiple organs along with hematological pathologies, including MDS, as well as characteristic bone marrow vacuolization of myeloid and erythroid precursors. This novel syndrome drove further attention to complex associations between MDS and adult-onset inflammatory conditions. The present narrative literature review discusses the clinical presentation, pathophysiology, management of concurrent MDS and systemic inflammatory diseases in parallel to the clinical picture of VEXAS syndrome.

Keywords: Autoinflammatory disease; Myelodysplastic syndromes; Systemic inflammation; VEXAS syndrome.

Publication types

  • Review

MeSH terms

  • Adult
  • Bone Marrow
  • Hereditary Autoinflammatory Diseases* / genetics
  • Humans
  • Mutation
  • Myelodysplastic Syndromes* / complications
  • Myelodysplastic Syndromes* / genetics
  • Ubiquitin-Activating Enzymes / genetics

Substances

  • Ubiquitin-Activating Enzymes