U. The hematopoietic stem cell transplantation comorbidity index is of prognostic relevance for patients with myelodysplastic syndrome. Haematologica 2009; 94:729-732. doi:10.3324/haematol.2008 This is an open-access paper.
ABSTRACT
The hematopoietic stem cell transplantation comorbidity index is of prognostic relevance for patients with myelodysplastic syndromeEsther Zipperer, Daniela Pelz, Kathrin Nachtkamp, Andrea Kuendgen, Corinna Strupp, Norbert Gattermann, Rainer Haas, and Ulrich Germing ing proper assessment of comorbidities becomes more important. However, there is currently no validated comorbidity score for patients with MDS. Nor is there any data on the prevalence and prognostic impact of comorbidities in MDS. We therefore studied the influence of comorbidities on the survival of MDS patients and evaluated the prognostic utility of the CCI and HCTCI in comparison with the International Prognostic Scoring System (IPSS).
Design and Methods
Study designOur retrospective study focused on patients who received best supportive care (BSC) only, including red blood cell transfusions, platelet transfusions, and treatment with erythropoietin. Patients undergoing induction chemotherapy and/or allogeneic stem cell transplantation were excluded. Patients were retrospectively classified according to CCI and HCTCI. Both scores were calculated from the points assigned to individual comorbidity factors. The clinical data were gathered from the original patients' charts. For each patient included in our analysis, the complete set of comorbidity factors was evaluable. Follow-up data were obtained from our outpatient clinic or by contacting the primary care physician. Local ethics approval for this study was obtained.
PatientsThe Düsseldorf MDS Registry includes about 3,300 patients, diagnosed between 1975 and 2008. Among these, 1,250 are classified according to the IPSS at the time of diagnosis. The latter group includes 740 patients who received BSC only. For 171 of those patients, all comorbidity factors required for applying the CCI and HCTCI were retrievable from the original records. As this study had a retrospective character, the quality of the documentation possibly varied between different patient files. Therefore, we included all available information on the patients including imaging and functional diagnostic procedures.This cohort included 114 male and 57 female patients. The median age at diagnosis was 69 (24-88) years. According to the IPSS, 23% of the patients under consideration were assigned to the low-risk group. The majority of patients belonged to the intermediate-1 (39%) and intermediate-2 (24%) risk groups, while the proportion of patients considered as high-risk was 14%.
Results and Discussion
Charlson Comorbidity IndexAccording to the CCl, 111 of 171 patients (65%) showed no comorbidities, while 37 (22%) had one, 15 (9%) had two, 2 had three, and 6 patients had four comorbidity factors. None of the patients accumulated more than four comorbidity factors.The most frequent diagnoses were diabetes w...
