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Published on: November 4, 2013
Impact of Comorbidities on Survival Among Patients with Chronic Myeloid Leukaemia Using the Charlson Comorbidity
Rafid A Abood1,2, Hasson M Hasson2, Asaad A Khalaf3
1Department of Medicine, Basra College of Medicine, Basra, Iraq.
Insights
Comorbidities, measured by the Charlson Comorbidity Index (CCI), did not significantly impact overall survival (OS) in chronic myeloid leukaemia (CML) patients. CML progression, not comorbidities, was the primary cause of death in this Iraqi cohort.
Area of Science:
- Hematology
- Oncology
- Epidemiology
Background:
- Comorbidities negatively affect survival in chronic diseases.
- The Charlson Comorbidity Index (CCI) is a common measure of comorbidity burden.
- Chronic myeloid leukaemia (CML) is a chronic malignancy treated with tyrosine kinase inhibitors.
Purpose of the Study:
- To assess the impact of comorbidities on overall survival (OS) in CML patients.
- To utilize the Charlson Comorbidity Index (CCI) for comorbidity assessment in CML.
- To investigate prognostic factors in CML patients treated with tyrosine kinase inhibitors.
Main Methods:
- Retrospective study of 247 CML patients (2006-2016) in Basra, Iraq.
- Calculation of CCI scores from hospital records.
- Comparison of OS between CCI groups (2-3 vs. ≥4) using Kaplan-Meier curves.
Main Results:
- No significant difference in mortality between CCI groups (9.6% vs. 8.6%, P=0.801).
- CML progression accounted for 69.6% of deaths, not comorbidities.
- CCI1 group (CCI 2-3) was younger (median 35 years) than CCI2 group (CCI ≥4, median 60 years).
Conclusions:
- The CCI score did not show a significant correlation with OS in this CML patient cohort.
- Further prospective studies are needed to explore associations with age, disease severity, and regional prognostic factors.
- Development of region-specific prognostic scales for CML may be beneficial.
Objectives:
In chronic diseases, comorbidities are known to have a strong negative association with overall survival (OS). This study aimed to use the Charlson Comorbidity Index (CCI) to examine the effect of comorbidities on OS among patients with chronic myeloid leukaemia (CML) treated with tyrosine kinase inhibitors.
Methods:
This retrospective study was conducted between January 2006 and October 2016 and included 247 CML patients treated at the Basra Oncology & Haematology Centre, Basra, Iraq. Information from hospital records was used to calculate CCI scores and patients were divided into groups based on scores of 2-3 (CCI1 group) or ≥4 (CCI2 group). The OS was calculated using Kaplan-Meier curves.
Results:
There were 177 (71.7%) patients in the CCI1 group and 70 (28.3%) in the CCI2 group. Overall, patients in the CCI1 group were significantly younger compared to those in the CCI2 group (median age: 35 versus 60 years; P <0.001); however, the gender distribution was similar in both groups (male-to-female ratio of 1:1.06 versus 1:1.18, respectively; P = 0.683). Diabetes mellitus was the most common comorbidity (17%), followed by hypertension (12%) and gastrointestinal diseases (6%). There were no significant differences in mortality between the groups (9.6% versus 8.6%; P = 0.801). In total, 69.6% of all deaths were related to CML progression rather than to the presence of comorbidities.
Conclusion:
No significant correlation was found between CCI score and OS among CML patients in Basra. However, larger long-term prospective studies are needed to evaluate associations with median age at diagnosis and disease severity and to develop region-specific prognostic scales.
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