Combination of Frailty Status and Comorbidity Score Improves the Stratification of Survival in Patients With Myelodysplastic Syndrome Owing to Good Predictive Capability for Infection-related Mortality

Sakatoku, Kazuki; Takeoka, Yasunobu; Miura, Asako; Araki, Toshihiko; Fujitani, Yoshio; Yamamura, Ryosuke; Nakamae, Hirohisa; Ohta, Kensuke; Hino, Masayuki

doi:10.1016/j.clml.2019.09.610

Cited by 19 publications

(13 citation statements)

References 33 publications

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“…Another limitation of our study is that global measures of performance status, such as the Clinical Frailty Scale 35 or the WHO/ECOG scale 36 were missing from our data. The Clinical Frailty Scale has been shown to predict mortality in MDS better than, and independent of, Charlson comorbidity index 37,38 . Accordingly, we cannot argue that the differences in treatment choice between patients from different socioeconomic strata must be based on poor judgement or prejudice.…”

Section: Discussionmentioning

confidence: 93%

Income, education and their impact on treatments and survival in patients with myelodysplastic syndromes

Larfors

Berggren

Garelius

et al. 2021

European J of Haematology

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Objectives To assess whether socioeconomic indices such as income and educational level can explain part of the variation in survival among patients with myelodysplastic syndromes, and further to assess whether these factors influence care and treatment decisions. Methods Population‐based cohort study on 2945 Swedish patients diagnosed between 2009 and 2018 and included in the Swedish MDS Register. Relative mortality was assessed by Cox regression, whereas treatment differences were assessed by Poisson regression. Regarding mortality, patients were also compared to a matched comparison group from the general population. Results Mortality was 50% higher among patients in the lowest income category compared to the highest and 40% higher in patients with mandatory school education only compared to those with college or university education. Treatment with hypomethylating agents and allogeneic stem cell transplantation, as well as investigation with cytogenetic diagnostics were also linked to income and education. The findings were not explained by differences in risk class or comorbidity at the time of diagnosis. Conclusions Income and education are linked to survival among patients with myelodysplastic syndromes. Socioeconomic status also seems to influence treatment intensity as patients with less income and education to a lesser degree receive hypomethylating agents and transplants.

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Section: Discussionmentioning

confidence: 93%

Income, education and their impact on treatments and survival in patients with myelodysplastic syndromes

Larfors

Berggren

Garelius

et al. 2021

European J of Haematology

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“… 70 , 71 In myelodysplastic syndromes, frailty was found to be independently predictive of infection-related mortality. 72 In a study of colon cancer patients ⩾70 years, frailty was independently associated with 1- and 5-year post-surgical survival. 73 A frailty index also predicted mortality from chemotherapy in advanced colon cancer patients 74 , 75 In another study of cancer patients ⩾65 years, weak grip strength – a measure of frailty – predicted chemotherapy toxicity but not mortality, while the ECOG score predicted mortality but not treatment toxicity.…”

Section: Frailty As a Risk Stratification Constructmentioning

confidence: 99%

Frailty in inflammatory bowel diseases: an emerging concept

Kochar

Orkaby

Ananthakrishnan

et al. 2021

Therap Adv Gastroenterol

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Inflammatory bowel diseases (IBD), consisting of Crohn’s disease and ulcerative colitis, are chronic remitting, relapsing inflammatory conditions of the gastrointestinal tract. While traditionally a disease of younger ages, the number of older adults with IBD is rising rapidly. Patients with IBD often experience geriatric syndromes at earlier ages. Older adults with IBD have poorer disease and treatment-related outcomes compared with younger adults with IBD. Applying the principles of geriatrics to understanding a chronic disease in older adults may improve health span. Better tools are needed to stratify IBD patients who are at high risk for adverse events. Frailty is a geriatric construct that may approximate biologic age. Frailty is a complex, multi-dimensional syndrome that leads to increased vulnerability to stress and decline of reserve across multiple physiologic systems. In this review, we present the leading conceptual models of frailty and discuss the applications of frailty in immune-mediated diseases. We also review chronic conditions where frailty has been applied successfully as a tool for risk stratification. Finally, we discuss in the detail the growing body of literature highlighting the relationship between frailty and IBD, the epidemiology of frailty in IBD, and ramifications of frailty in IBD.

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“…Frailty can be assessed using objective measures like the clinical frailty scale (CFS) (37). In a study on 118 MDS patients, Sakatoku et al reported that CFS (≥ 5 vs. < 5; hazard ratio [HR], 3.37; P = .002) independently predicted OS on multivariate analysis (38). The HCT-CI score is used when evaluating comorbidities and a score of 3 to 4 and ≥ 5 have been shown to have significantly higher risk of mortality (39,40).…”

Section: B Allobmt Eligibilitymentioning

confidence: 99%

BMT for Myelodysplastic Syndrome: When and Where and How

Jain

Elmariah

2022

Front. Oncol.

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Myelodysplastic syndromes (MDS) are a diverse group of hematological malignancies distinguished by a combination of dysplasia in the bone marrow, cytopenias and the risk of leukemic transformation. The hallmark of MDS is bone marrow failure which occurs due to selective growth of somatically mutated clonal hematopoietic stem cells. Multiple prognostic models have been developed to help predict survival and leukemic transformation, including the international prognostic scoring system (IPSS), revised international prognostic scoring system (IPSS-R), WHO prognostic scoring system (WPSS) and MD Anderson prognostic scoring system (MDAPSS). This risk stratification informs management as low risk (LR)-MDS treatment focuses on improving quality of life and cytopenias, while the treatment of high risk (HR)-MDS focuses on delaying disease progression and improving survival. While therapies such as erythropoiesis stimulating agents (ESAs), erythroid maturation agents (EMAs), immunomodulatory imide drugs (IMIDs), and hypomethylating agents (HMAs) may provide benefit, allogeneic blood or marrow transplant (alloBMT) is the only treatment that can offer cure for MDS. However, this therapy is marred, historically, by high rates of toxicity and transplant related mortality (TRM). Because of this, alloBMT is considered in a minority of MDS patients. With modern techniques, alloBMT has become a suitable option even for patients of advanced age or with significant comorbidities, many of whom who would not have been considered for transplant in prior years. Hence, a formal transplant evaluation to weigh the complex balance of patient and disease related factors and determine the potential benefit of transplant should be considered early in the disease course for most MDS patients. Once alloBMT is recommended, timing is a crucial consideration since delaying transplant can lead to disease progression and development of other comorbidities that may preclude transplant. Despite the success of alloBMT, relapse remains a major barrier to success and novel approaches are necessary to mitigate this risk and improve long term cure rates. This review describes various factors that should be considered when choosing patients with MDS who should pursue transplant, approaches and timing of transplant, and future directions of the field.

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Combination of Frailty Status and Comorbidity Score Improves the Stratification of Survival in Patients With Myelodysplastic Syndrome Owing to Good Predictive Capability for Infection-related Mortality

Cited by 19 publications

References 33 publications

Income, education and their impact on treatments and survival in patients with myelodysplastic syndromes

Income, education and their impact on treatments and survival in patients with myelodysplastic syndromes

Frailty in inflammatory bowel diseases: an emerging concept

BMT for Myelodysplastic Syndrome: When and Where and How

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