TY - JOUR
T1 - Patient-related factors independently impact overall survival in patients with myelodysplastic syndromes
T2 - an MDS-CAN prospective study
AU - Buckstein, Rena
AU - Wells, Richard A.
AU - Zhu, Nancy
AU - Leitch, Heather A.
AU - Nevill, Thomas J.
AU - Yee, Karen W.L.
AU - Leber, Brian
AU - Sabloff, Mitchell
AU - St. Hilaire, Eve
AU - Kumar, Rajat
AU - Geddes, Michelle
AU - Shamy, April
AU - Storring, John
AU - Kew, Andrea
AU - Elemary, Mohamed
AU - Levitt, Max
AU - Lenis, Martha
AU - Mamedov, Alex
AU - Zhang, Liying
AU - Rockwood, Ken
AU - Alibhai, Shabbir M.H.
N1 - Funding Information:
We would like to acknowledge funding from Canadian Institute of Health Research Operating Bridge Grant #246089, Celgene Canada for unrestricted research funding to its ongoing support of the national registry and the Crashley Estate. We also want to acknowledge all the Canadian MDS patients and their families for their participation.
Publisher Copyright:
© 2016 John Wiley & Sons Ltd
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Little is known about the effects of frailty, disability and physical functioning on the clinical outcomes for myelodysplastic syndromes (MDS). We investigated the predictive value of these factors on overall survival (OS) in 445 consecutive patients with MDS and chronic monomyelocytic leukaemia (CMML) enrolled in a multi-centre prospective national registry. Frailty, comorbidity, instrumental activities of daily living, disability, quality of life, fatigue and physical performance measures were evaluated at baseline and were added as covariates to conventional MDS-related factors as predictors of OS in Cox proportional hazards models. The median age was 73 years, and 79% had revised International Prognostic Scoring System (IPSS-R) risk scores of intermediate or lower. Frailty correlated only modestly with comorbidity. OS was significantly shorter for patients with higher frailty and comorbidity scores, any disability, impaired grip strength and timed chair stand tests. By multivariate analysis, the age-adjusted IPSS-R, frailty (Hazard ratio 2·7 (95% confidence interval [CI] 1·7–4·2), P < 0·0001) and Charlson comorbidity score (Hazard ratio 1·8 (95% CI 1·1–2·8), P = 0·01) were independently prognostic of OS. Incorporation of frailty and comorbidity scores improved risk stratification of the IPSS-R by 30% and 5%, respectively. These data demonstrate for the first time, the importance of considering frailty in prognostic models and a potential target for therapeutic intervention in optimizing clinical outcomes in older MDS patients. Trial Registration: ClinicalTrials.gov Identifier: NCT02537990.
AB - Little is known about the effects of frailty, disability and physical functioning on the clinical outcomes for myelodysplastic syndromes (MDS). We investigated the predictive value of these factors on overall survival (OS) in 445 consecutive patients with MDS and chronic monomyelocytic leukaemia (CMML) enrolled in a multi-centre prospective national registry. Frailty, comorbidity, instrumental activities of daily living, disability, quality of life, fatigue and physical performance measures were evaluated at baseline and were added as covariates to conventional MDS-related factors as predictors of OS in Cox proportional hazards models. The median age was 73 years, and 79% had revised International Prognostic Scoring System (IPSS-R) risk scores of intermediate or lower. Frailty correlated only modestly with comorbidity. OS was significantly shorter for patients with higher frailty and comorbidity scores, any disability, impaired grip strength and timed chair stand tests. By multivariate analysis, the age-adjusted IPSS-R, frailty (Hazard ratio 2·7 (95% confidence interval [CI] 1·7–4·2), P < 0·0001) and Charlson comorbidity score (Hazard ratio 1·8 (95% CI 1·1–2·8), P = 0·01) were independently prognostic of OS. Incorporation of frailty and comorbidity scores improved risk stratification of the IPSS-R by 30% and 5%, respectively. These data demonstrate for the first time, the importance of considering frailty in prognostic models and a potential target for therapeutic intervention in optimizing clinical outcomes in older MDS patients. Trial Registration: ClinicalTrials.gov Identifier: NCT02537990.
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U2 - 10.1111/bjh.14033
DO - 10.1111/bjh.14033
M3 - Article
C2 - 26991631
AN - SCOPUS:84976498280
SN - 0007-1048
VL - 174
SP - 88
EP - 101
JO - British Journal of Haematology
JF - British Journal of Haematology
IS - 1
ER -