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

Eur J Haematol. 2019 Jul;103(1):56-63. doi: 10.1111/ejh.13243. Epub 2019 May 16.

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.

Keywords: myelodysplastic syndrome; prospective; survival.

MeSH terms

  • Aged
  • Case-Control Studies
  • Chromosome Aberrations
  • Factor Analysis, Statistical
  • Female
  • Humans
  • Male
  • Middle Aged
  • Minnesota / epidemiology
  • Myelodysplastic Syndromes / diagnosis
  • Myelodysplastic Syndromes / epidemiology*
  • Myelodysplastic Syndromes / mortality
  • Myelodysplastic Syndromes / therapy
  • Odds Ratio
  • Population Surveillance
  • Prognosis
  • Socioeconomic Factors