Factors predicting early mortality after new diagnosis of myelodysplastic syndrome: A population‐based study

Abstract

Objective Little prospective data regarding factors determining patient outcomes in myelodysplastic syndromes (MDS) are available. To establish features of early mortality in MDS, we compare characteristics of patients dying within 1 year of diagnosis with those surviving longer. Methods We prospectively enrolled adults with a new MDS diagnosis in a population‐based case‐control study. Logistic regression was used to calculate odds ratios and 95% confidence intervals for potential predictors of early mortality. Subgroup analyses were conducted within the following groups: high‐/very‐high‐risk IPSS‐R; very‐low‐/low‐/intermediate‐risk IPSS‐R; treated patients; and supportive care only patients. Results We observed early mortality in those with abnormal cytogenetics (OR: 3.36, 95% CI: 1.52‐7.46), three or greater cytogenetic abnormalities (OR: 3.48, 95% CI: 1.51‐7.99), treatment at a community medical center (versus academic) (OR: 2.55, 95% CI: 1.18‐5.47), and with 2‐3 concurrent medical comorbidities (OR: 2.14, 95% CI: 1.08‐4.22). Similarly, in subgroup analyses, abnormal cytogenetics remained the main predictor of early mortality. Conclusion Complex cytogenetics and prognostic risk category have been associated with early mortality without intervention. Our data confirm these associations in a large, prospectively followed cohort and highlight the significance of cytogenetic abnormalities and complexity regardless of IPSS‐R risk categorization or treatment.

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

“…As mentioned in the background section, four studies from various regions of North America and Europe have failed to demonstrate survival differences in MDS patients based on socioeconomic factors 12‐15 . As socioeconomic differences depend on the population studied, the discrepancy between their and our results could be correct.…”

“…As socioeconomic differences depend on the population studied, the discrepancy between their and our results could be correct. However, the four previous studies were substantially smaller, with analyses on socioeconomic factors on cohorts ranging from 159 13 to 399 patients 12 . They might thus have been underpowered to detect differences demonstrated in our material, encompassing approximately ten times as many patients as each of the previous studies.…”

“…A study based on SEER data from the United States found higher mortality in MDS patients from low‐ or medium‐income areas compared to high‐income areas 11 . However, smaller studies from Minnesota, 12 Maryland, 13 Ontario 14 and Scotland, 15 have failed to replicate this finding, and authors have suggested that the reported differences in the larger US study could derive from unequal access to primary care.…”

Comorbidities and malignancies negatively affect survival in myelodysplastic syndromes: a population-based study

“…The number of patients undergoing transplantation was 8%, which is in line with other population-based studies. 7,8 Transplantation was considered part of treatment during follow-up and was not included in the multivariable analysis. OS was also dependent on sex.…”

“…1 In studies, patients with t-MDS tend to have worse overall survival (OS) than de novo MDS patients, but only limited population-based data are available. [4][5][6][7] MDS predominantly manifests in the elderly, with a median age at diagnosis of 70 to 75 years. [8][9][10] Elderly patients often have multiple chronic diseases, such as diabetes mellitus, cardiovascular disease, and chronic pulmonary disease.…”