Cause of death in patients with lower-risk myelodysplastic syndrome (MDS)

Abstract

7096 Background: We have recently developed a risk model specific for patients (pts) with lower risk MDS (Leukemia; in press) that allows the identification of poor prognosis pts. The cause of death (COD) of these pts is not well understood and relevant in view of their median age and their comorbidities. Methods: We reviewed data from 619 deceased pts with low or intermediate-1 disease by IPSS at presentation to MDACC from 1977 to 2006. Autopsy, final progress note, physician letter, or death certificate were used to determine COD. Each COD was arranged into an organ system and stratified by decade. Chi-square analysis and Kaplan-Meier log rank testing were utilized to detect differences between decades. Results: Information to determine COD was only available in 276 pts (45%). The median age at presentation was 66 years (range 19–88). The median age at time of death was 67 years (range 21–91). Overall median survival was 59 weeks (range = 1–831). An increase in median survival was noted from 1980 to 1990, 1990 to 2000, and 2000 to present (31, 57, and 79 weeks respectively, p = 0.004). A total of 88 pts (32%) transformed to AML prior to death, and the rate was stable over time (p = 0.654). By FAB classification, all subgroups were identified (RA = 114, RARS = 16, RAEB = 79, RAEB-t = 34, CMML = 33). By IPSS score, most pts were Intermediate-1 (Int-1 = 218 and Low = 58). Most pts had diploid cytogenetics (58.3%), and the most common cytogenetic abnormality was deletion of chromosome 5 (9.1%). Etiologies of infectious COD (p = 0.01) and renal COD (p = 0.003) declined over time, while hematological causes increased over each decade (p < 0.001). Other COD that were stable over time included cardiovascular, pulmonary, gastrointestinal, neurological, and oncologic causes. Sepsis (n = 40) and pneumonia (n = 39) were the most common infectious COD, but only pneumonia-related COD decreased over each decade (p = 0.003). MDS (n = 32) and AML (n = 29) were the primary hematological COD. Conclusions: This cohort of pts had a shorter median survival compared to historic controls, though median survival did improve with each decade. In addition, the most common COD has shifted over time, which may represent changes in practice. No significant financial relationships to disclose.