Risk stratification based on both disease status and extra-hematologic comorbidities in patients with myelodysplastic syndrome
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Open Access
- 6 December 2010
- journal article
- Published by Ferrata Storti Foundation (Haematologica) in Haematologica
- Vol. 96 (3), 441-449
- https://doi.org/10.3324/haematol.2010.033506
Abstract
The incidence of myelodysplastic syndromes increases with age and a high prevalence of co-morbid conditions has been reported in these patients. So far, risk assessment in myelodysplastic syndromes has been mainly based on disease status. We studied the prognostic impact of comorbidity on the natural history of myelodysplastic syndrome with the aim of developing novel tools for risk assessment. The study population included a learning cohort of 840 patients diagnosed with myelodysplastic syndrome in Pavia, Italy, and a validation cohort of 504 patients followed in Duesseldorf, Germany. Information on comorbidity was extracted from detailed review of the patients’ medical charts and laboratory values at diagnosis and during the course of the disease. Univariable and multivariable survival analyses with both fixed and time-dependent covariates were performed using Cox’s proportional hazards regression models. Comorbidity was present in 54% of patients in the learning cohort. Cardiac disease was the most frequent comorbidity and the main cause of non-leukemic death. In multivariable analysis, comorbidity had a significant impact on both non-leukemic death (P=0.01) and overall survival (P=0.02). Cardiac, liver, renal, pulmonary disease and solid tumors were found to independently affect the risk of non-leukemic death. A time-dependent myelodysplastic syndrome-specific comorbidity index (MDS-CI) was developed for predicting the effect of comorbidity on outcome. This identified three groups of patients which showed significantly different probabilities of non-leukemic death (PP=0.005) also in the validation cohort. Landmark survival analyses at fixed time points from diagnosis showed that the MDS-CI can better define the life expectancy of patients with myelodysplastic syndrome stratified according to the WHO-classification based Prognostic Scoring System (WPSS).Comorbidities have a significant impact on the outcome of patients with myelodysplastic syndrome. Accounting for both disease status by means of the WPSS and comorbidity through the MDS-CI considerably improves risk stratification in myelodysplastic syndromes.This publication has 37 references indexed in Scilit:
- Allogeneic stem cell transplantation for myelodysplastic syndromes with bone marrow fibrosisHaematologica, 2010
- Value of allogeneic versus autologous stem cell transplantation and chemotherapy in patients with myelodysplastic syndromes and secondary acute myeloid leukemia. Final results of a prospective randomized European Intergroup TrialHaematologica, 2010
- Prognostic impact of pre-transplantation transfusion history and secondary iron overload in patients with myelodysplastic syndrome undergoing allogeneic stem cell transplantation: a GITMO studyHaematologica, 2009
- Clinical relevance of extra-hematologic comorbidity in the management of patients with myelodysplastic syndromeHaematologica, 2009
- The hematopoietic stem cell transplantation comorbidity index is of prognostic relevance for patients with myelodysplastic syndromeHaematologica, 2009
- Hematopoietic cell transplantation–specific comorbidity index as an outcome predictor for patients with acute myeloid leukemia in first remission: combined FHCRC and MDACC experiencesBlood, 2007
- New insights into the prognostic impact of the karyotype in MDS and correlation with subtypes: evidence from a core dataset of 2124 patientsBlood, 2007
- Comorbid Disease and Cancer: The Need for More Relevant Conceptual Models in Health Services ResearchJournal of Clinical Oncology, 2005
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987
- A new look at the statistical model identificationIEEE Transactions on Automatic Control, 1974