Excess mortality in the myelodysplastic syndromes

Area of Science:

• Hematology
• Oncology
• Epidemiology

Background:

• Myelodysplastic syndromes (MDS) are prevalent hematologic malignancies in the elderly.
• The true disease burden of MDS is underestimated as many patients succumb to age-related conditions.
• Excess mortality in MDS patients, particularly from non-leukemic causes, requires thorough investigation.

Purpose of the Study:

• To quantify the excess mortality attributable to primary Myelodysplastic syndromes (MDS).
• To identify factors influencing excess mortality in MDS patients.
• To evaluate trends in excess mortality over time and by risk stratification.

Main Methods:

• Registry-based study analyzing 7,408 adult patients diagnosed with primary MDS between 1980 and 2014.
• Excess mortality calculated by comparing patient survival against expected survival in a matched general population.
• Analysis of factors including age, sex, and Revised International Prognostic Scoring System (IPSS-R) risk category.

Main Results:

• Excess mortality accounted for 75% of all-cause mortality in MDS patients.
• Excess mortality was significantly higher in older males and increased with higher IPSS-R risk categories (IRR: 2.1).
• A recent increase in excess mortality was observed in higher-risk MDS patients, potentially linked to age-related comorbidities.

Conclusions:

• Myelodysplastic syndromes impose a substantial excess mortality burden, even in lower-risk groups, driven by non-leukemic factors.
• Older age, male sex, and higher disease risk are independently associated with increased excess mortality.
• The findings advocate for integrated treatment approaches addressing both MDS and associated age-related conditions.