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[Prognostic evaluation of comorbidities in patients with myelodysplastic syndrome]
Yi Li1, Tiejun Qin1, Zefeng Xu1
1Institute of Hematology and Hospital of Blood Disease, Chinese Academe of Medical Scienses & Peking Union Medical College, State Key Laboratory of Experimental Hematology, Tianjin 300020, China.
Insights
Comorbidities significantly impact outcomes for myelodysplastic syndromes (MDS) patients. The MDS-specific comorbidity index (MDS-CI) offers prognostic stratification independently of the IPSS-R score.
Area of Science:
- Hematology
- Oncology
- Clinical Medicine
Background:
- Myelodysplastic syndromes (MDS) are a group of clonal hematopoietic stem cell disorders.
- Comorbidities are common in MDS patients and can influence treatment decisions and outcomes.
- Accurate prognostic assessment is crucial for effective MDS management.
Purpose of the Study:
- To evaluate the impact of comorbidities on the clinical outcomes of patients diagnosed with myelodysplastic syndromes (MDS).
- To assess the prognostic value of comorbidities, particularly using the MDS-specific comorbidity index (MDS-CI).
Main Methods:
- Retrospective analysis of clinical characteristics and comorbidities in 676 MDS patients.
- Comparison of outcomes between patients with and without comorbidities.
- Application of univariate and multivariate analyses to determine prognostic significance.
- Stratification using the MDS-specific comorbidity index (MDS-CI) and International Prognostic Scoring System-Revised (IPSS-R).
Main Results:
- 58.4% of MDS patients had comorbidities, associated with older age, higher bone marrow blasts, abnormal karyotype, and different WHO 2008 subtypes and IPSS-R risk.
- Comorbidities demonstrated independent prognostic significance in both univariate and multivariate analyses (P<0.001).
- The MDS-CI significantly stratified survival across risk groups, with median survival ranging from 13 to 96 months based on comorbidity burden.
Conclusions:
- Comorbidities are prevalent in MDS patients and significantly affect survival.
- The MDS-specific comorbidity index (MDS-CI) provides independent prognostic information.
- Comorbidity assessment, alongside IPSS-R, enhances prognostic stratification for MDS patients.
Objective:
To discuss the impact of comorbidities on the outcomes of patients with MDS.
Methods:
The clinical characteristics of 676 MDS patients with detailed comorbidities evaluations was analyzed retrospectively.
Results:
There were 395/676 cases (58.4%) with comorbidities (group 1), 281/676 cases (41.6%) without (group 2). Significant differences were seen in the distribution of age (≥ 60 y), bone marrow blasts, abnormal karyotype, WHO 2008 subtypes and IPSS-R risk cohorts (P<0.05) between the two groups. While gender, HGB concentrations, WBC levels, platelet levels and serum ferritin were not significantly different (P>0.05). Independent prognostic significance of comorbidities was seen in both uni-variate and multi-variate analyses (P<0.001). According to MDS-specific comorbidity index (MDS-CI), the median survival were 32(1-153) months, 19(2-85) months and 13(1-37) months in the low-risk, intermediate-risk and high-risk cohorts respectively, while 96(1-166) months in cohorts without any comorbidities, of which significant differences were seen (P<0.001). The MDS-CI allowed further stratification in the IPSS-R low-risk, intermediate-risk and high-risk cohorts (P<0.001).
Conclusion:
Comorbidities provides prognostic stratification independently of IPSS-R for MDS patients.
