Koster Kira-Lee, Messerich Nora-Medea, Volken Thomas, Cogliatti Sergio, Lehmann Thomas, Graf Lukas, Holbro Andreas, Benz Rudolf, Demmer Izadora, Jochum Wolfram, Rao Tata Nageswara, Silzle Tobias
Clinic for Medical Oncology and Hematology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland.
Department of Intensive Care, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland.
Cancers (Basel). 2023 Sep 24;15(19):4698. doi: 10.3390/cancers15194698.
In myelofibrosis, comorbidities (CMs) add prognostic information independently from the Dynamic International Prognostic Scoring System (DIPSS). The Myelodysplastic Syndrome-Specific Comorbidity Index (MDS-CI) offers a simple tool for CM assessment as it is calculable after having performed a careful history and physical examination, a small routine chemistry panel (including creatinine and liver enzymes) and a limited set of functional diagnostics. To assess the prognostic impact of the MDS-CI in addition to the DIPSS and the Mutation-Enhanced International Prognostic Scoring System (MIPSS)-70, we performed a retrospective chart review of 70 MF patients who had not received allogeneic stem cell transplantation (primary MF, n = 51; secondary MF, n = 19; median follow-up, 40 months) diagnosed at our institution between 2000 and 2020. Cardiac diseases (23/70) and solid tumors (12/70) were the most common CMs observed at MF diagnosis. Overall survival (OS) was significantly influenced by the MDS-CI (median OS MDS-CI low (n = 38): 101 months; MDS-CI intermediate (n = 25): 50 months; and high (n = 7): 8 months; < 0.001). The MDS-CI added prognostic information after inclusion as a categorical variable in a multivariate model together with the dichotomized DIPSS or the dichotomized MIPSS70: MDS-CI high HR 14.64 (95% CI 4.42; 48.48), = 0.0002, and MDS-CI intermediate HR 1.97 (95% CI 0.96; 4.03), = 0.065, and MDS-CI high HR 19.65 (95% CI 4.71; 81.95), < 0.001, and MDS-CI intermediate HR 1.063 (95% CI 0.65; 4.06), = 0.2961, respectively. The analysis of our small and retrospective MF cohort suggests that the MDS-CI represents a useful tool to identify MF patients with an increased vulnerability due to comorbidities. However, analyses of larger cohorts are necessary to define the value of the MDS-CI as a prognostic tool in comparison with other comorbidity indices.
在骨髓纤维化中，合并症（CMs）独立于动态国际预后评分系统（DIPSS）增加预后信息。骨髓增生异常综合征特异性合并症指数（MDS-CI）为CM评估提供了一个简单工具，因为在进行仔细的病史和体格检查、小型常规化学检查（包括肌酐和肝酶）以及一组有限的功能诊断后即可计算得出。为了评估MDS-CI除DIPSS和突变增强国际预后评分系统（MIPSS）-70之外的预后影响，我们对2000年至2020年在我们机构诊断的70例未接受异基因干细胞移植的骨髓纤维化患者（原发性骨髓纤维化，n = 51；继发性骨髓纤维化，n = 19；中位随访时间40个月）进行了回顾性病历审查。心脏病（23/70）和实体瘤（12/70）是骨髓纤维化诊断时观察到的最常见合并症。总生存期（OS）受MDS-CI显著影响（MDS-CI低分组（n = 38）的中位OS：101个月；MDS-CI中等分组（n = 25）：50个月；高分组（n = 7）：8个月；<0.001）。在多变量模型中，将MDS-CI作为分类变量与二分法DIPSS或二分法MIPSS70一起纳入后，MDS-CI增加了预后信息：MDS-CI高分组HR 14.64（95%CI 4.42；48.48），P = 0.0002，MDS-CI中等分组HR 1.97（95%CI 0.96；4.03），P = 0.065，以及MDS-CI高分组HR 19.65（95%CI 4.71；81.95），P < 0.001，MDS-CI中等分组HR 1.063（95%CI 0.65；4.06），P = 0.2961。对我们这个小型回顾性骨髓纤维化队列的分析表明，MDS-CI是识别因合并症而易感性增加的骨髓纤维化患者的有用工具。然而，与其他合并症指数相比，需要对更大的队列进行分析以确定MDS-CI作为预后工具的价值。
