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Community-acquired infections and their association with myeloid malignancies
Glen J Titmarsh1, Mary Frances McMullin2, Charlene M McShane1
1Centre for Public Health, Institute of Clinical Sciences, Block B, Queens University Belfast, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland, United Kingdom.
Introduction:
Antigenic stimulation is a proposed aetiologic mechanism for many haematological malignancies. Limited evidence suggests that community-acquired infections may increase the risk of acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS). However, associations with other myeloid malignancies including chronic myeloid leukaemia (CML) and myeloproliferative neoplasms (MPNs) are unknown.
Materials And Methods:
Using the Surveillance, Epidemiology and End Result (SEER)-Medicare database, fourteen community-acquired infections were compared between myeloid malignancy patients [AML (n=8489), CML (n=3626) diagnosed 1992-2005; MDS (n=3072) and MPNs (n=2001) diagnosed 2001-2005; and controls (200,000 for AML/CML and 97,681 for MDS/MPN]. Odds ratios (ORs) and 95% confidence intervals were adjusted for gender, age and year of selection excluding infections diagnosed in the 13-month period prior to selection to reduce reverse causality.
Results:
Risk of AML and MDS respectively, were significantly associated with respiratory tract infections, bronchitis (ORs 1.20 [95% CI: 1.14-1.26], 1.25 [95% CI: 1.16-1.36]), influenza (ORs 1.16 [95% CI: 1.07-1.25], 1.29 [95% CI: 1.16-1.44]), pharyngitis (ORs 1.13 [95% CI: 1.06-1.21], 1.22 [95% CI: 1.11-1.35]), pneumonia (ORs 1.28 [95% CI: 1.21-1.36], 1.52 [95% CI: 1.40-1.66]), sinusitis (ORs 1.23 [95% CI: 1.16-1.30], 1.25 [95% CI: 1.15-1.36]) as was cystitis (ORs 1.13 [95% CI: 1.07-1.18], 1.26 [95% CI: 1.17-1.36]). Cellulitis (OR 1.51 [95% CI: 1.39-1.64]), herpes zoster (OR 1.31 [95% CI: 1.14-1.50]) and gastroenteritis (OR 1.38 [95% CI: 1.17-1.64]) were more common in MDS patients than controls. For CML, associations were limited to bronchitis (OR 1.21 [95% CI: 1.12-1.31]), pneumonia (OR 1.49 [95% CI: 1.37-1.62]), sinusitis (OR 1.19 [95% CI: 1.09-1.29]) and cellulitis (OR 1.43 [95% CI: 1.32-1.55]) following Bonferroni correction. Only cellulitis (OR 1.34 [95% CI: 1.21-1.49]) remained significant in MPN patients. Many infections remained elevated when more than 6 years of preceding claims data were excluded.
Discussion:
Common community-acquired infections may be important in the malignant transformation of the myeloid lineage. Differences in the aetiology of classic MPNs and other myeloid malignancies require further exploration.
Insights
Community-acquired infections, such as respiratory infections and cellulitis, are linked to increased risks of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). These infections may play a role in myeloid lineage malignant transformation.
Area of Science:
- Hematology
- Oncology
- Epidemiology
Background:
- Antigenic stimulation is a proposed mechanism in hematological malignancies.
- Limited evidence links community-acquired infections to acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS).
- Associations between infections and chronic myeloid leukemia (CML) or myeloproliferative neoplasms (MPNs) are largely unknown.
Purpose of the Study:
- To investigate the association between community-acquired infections and various myeloid malignancies.
- To explore potential links between infections and AML, MDS, CML, and MPNs.
Main Methods:
- Utilized the SEER-Medicare database for a large-scale case-control study.
- Compared fourteen community-acquired infections in patients with AML, CML, MDS, and MPNs against control groups.
- Adjusted for demographic factors and excluded infections within 13 months prior to diagnosis to mitigate reverse causality.
Main Results:
- Significant associations found between AML/MDS and respiratory infections (bronchitis, influenza, pharyngitis, pneumonia, sinusitis), and cystitis.
- MDS patients showed higher risks associated with cellulitis, herpes zoster, and gastroenteritis.
- CML showed associations with bronchitis, pneumonia, sinusitis, and cellulitis; MPN risk was primarily linked to cellulitis.
Conclusions:
- Common community-acquired infections may contribute to the malignant transformation of myeloid cells.
- Distinct etiological factors may underlie classic MPNs compared to other myeloid malignancies, warranting further research.
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