Comorbidities and prognosis of myelodysplastic syndromes

Abstract

7086 Background: Cancer patients often experience comorbidities that may affect their therapeutic plan, prognosis, and outcome. Few studies have evaluated comorbidities in myelodysplastic syndromes (MDS). The aim of our study was to determine the effect of comorbidity on the survival of patients with MDS. Methods: We reviewed the medical records of consecutive adult MDS patients who presented to our comprehensive cancer center in 2002. The Adult Comorbidity Evaluation-27 (ACE-27), a validated 27-item comorbidity index for cancer patients, was used to assess the severity of comorbid conditions. For each patient, we obtained demographic data and specific staging information based on the International Prognostic Scoring System (IPSS). We also collected information on bone marrow transplantation (BMT), mortality and survival. Kaplan-Meier methods and log-rank tests were used to assess survival. Results: Of the 55 patients included in this preliminary report, 41 (74.5%) were male, and 47 (85.5%) were white; mean age was 66.4 years; mean follow-up 22.2 months. The three most common comorbidities were hypertension, diabetes mellitus, and coronary artery disease. A total of 90.9% of patients had an IPSS risk of intermediate or higher. The ACE-27 comorbidity scores were as follows: none, 18 patients (32.7%); mild, 17 (30.9%); moderate, 9 (16.4%); and severe, 11 (20.0%). Fifty patients (90.9%) died, whereas 9 (16.4%) underwent BMT. Median survival according to ACE-27 scores was: 22 months for patients with no comorbidity, 11 months for patients with mild or moderate comorbidity, and 8 months for those with severe comorbidity; this trend did not reach statistical significance (p = 0.42). A linear trend was observed between the severity of comorbidity and having received BMT: half of the patients with no comorbidities received BMT compared to none in the group with a severe score (p = 0.02). Conclusions: A small trend was observed between survival and comorbidity. Most of our patients had an advanced IPSS stage which may have decreased the strength of this association. Patients with comorbid conditions received BMT less often than those without comorbidity. Further studies are needed to evaluate the effects of comorbidities on the prognosis and therapeutic options of patients with early-stage MDS. No significant financial relationships to disclose.