Bammer Christoph, Sperr Wolfgang R, Kemmler Georg, Wimazal Friedrich, Nösslinger Thomas, Schönmetzler Anabel, Krieger Otto, Pfeilstöcker Michael, Valent Peter, Stauder Reinhard
Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria.
Department of Internal Medicine I, Division of Hematology and Hemostaseology, Vienna Medical University, Vienna, Austria.
J Geriatr Oncol. 2014 Jul;5(3):299-306. doi: 10.1016/j.jgo.2014.02.002. Epub 2014 Mar 11.
Myelodysplastic syndromes (MDS) are typical diseases of the elderly. The clinical outcome of a well-characterized cohort of patients with MDS was analyzed for prevalence and impact of comorbidities to establish the basis for tailored treatment algorithms. Focus was on age- and sex-related differences.
The hematopoietic cell transplantation-comorbidity index (HCT-CI) was assessed in 616 well-defined patients from the Austrian MDS platform (median age: 71years).
Most patients displayed one (24.5%) or more (23.7%) comorbidities. The highest frequencies were observed for cardiovascular disease (28.4%), diabetes (12.2%), and prior tumors (9.9%). Comorbidities were more frequent (mean number: 0.92 vs. 0.74 [male vs. female]; p=0.030) and more severe in men than in women (mean HCT-CI score: 1.41 vs. 1.09 [male vs. female]; p=0.016). Elderly patients (65+years) showed a higher prevalence of comorbidities than younger patients (HCT-CI score: 1.52, mean in 65+, vs. 0.24 and 0.76 in <45years and 46-65years, respectively) (p<0.001). These differences were most pronounced for cardiovascular disease, diabetes, and prior tumors (p<0.001). Presence of cardiac arrhythmia or prior solid tumor was significantly associated with shorter overall survival (p=0.023, 0.024, respectively). Moreover, HCT-CI risk grouping remained an independent prognostic parameter for survival in multivariate analysis.
Comorbidities impact clinical outcome in elderly patients with MDS. Distinct diseases cluster in an age- and sex-related manner, which may have clinical implications when designing individualized therapies. Comorbidities should be evaluated with established scores and integrated in decision making.
骨髓增生异常综合征（MDS）是典型的老年疾病。分析一组特征明确的MDS患者的临床结局，以确定合并症的患病率及其影响，从而为量身定制的治疗方案奠定基础。重点关注年龄和性别相关差异。
对来自奥地利MDS平台的616例明确诊断的患者（中位年龄：71岁）评估造血细胞移植合并症指数（HCT-CI）。
大多数患者有1种（24.5%）或更多（23.7%）合并症。心血管疾病（28.4%）、糖尿病（12.2%）和既往肿瘤（9.9%）的发生率最高。男性合并症比女性更常见（平均数：0.92对0.74[男性对女性]；p=0.030）且更严重（平均HCT-CI评分：1.41对1.09[男性对女性]；p=0.016）。老年患者（65岁及以上）合并症的患病率高于年轻患者（HCT-CI评分：65岁及以上平均为1.52，45岁以下和46-65岁分别为0.24和0.76）（p<0.001）。这些差异在心血管疾病、糖尿病和既往肿瘤方面最为明显（p<0.001）。存在心律失常或既往实体瘤与总生存期缩短显著相关（分别为p=0.023、0.024）。此外，在多变量分析中，HCT-CI风险分组仍然是生存的独立预后参数。
合并症影响老年MDS患者的临床结局。不同疾病以年龄和性别相关的方式聚集，这在设计个体化治疗方案时可能具有临床意义。应使用既定评分评估合并症并将其纳入决策过程。
