Hematological, clinical, morphological characteristics and comorbidity indexes in myelodysplastic syndrome

ABSTRACTMany scoring methods such as International Prognostic Scoring System(IPSS) and WHO classification-based Prognostic Scoring System(WPSS) were developed as predictors of survival in Myelodysplastic syndromes(MDS) and transformation to acute myeloid leukemia(AML) and these scoring systems are based on multiple prognostically important parameters, including bone marrow blasts, karyotype, and number of cytopenias. Patient-related factors like chronic comorbid conditions, poor performance status, and abnormal organ function may also influence the outcome, especially the survival in patients with MDS. This seems to be of particular importance as MDS is found primarily in elderly patients. Different scoring methods were developed in various studies made in this direction but the validity of these methods in different patient groups has not been put forward clearly. Our aim was to examine the effects of disease-related scorings such as IPSS and WPSS, patient-specific Charlson Comorbidity Indexes (CCI) and Hematopoietic Stem Cell Transplantation-Specific Comorbidity Index (HCT-CI) scorings on survival with our own de novo MDS patient pool.200 patients who were diagnosed with de novo MDS between the years 1990 and 2011 by our centre were included in the study. Demographic, clinic features and comorbid diseases of patients at the time of the diagnosis were noted down. The effects of IPSS, WPSS and comorbidity indexes (CCI and HCT-CI) that were calculated with available data on overall survival (OS) and Leukemia Free Survival (LFS) were analyzed.The median age of the 200 patients who were included in the study was 70 (29-93); 80 of the patients were women (40%) and 120 of them were men (60%). Mean follow-up period of the study was 18 months (5-168) and 132 (66%) patients died during the course of the study. Median overall survival was 25 (18,1-31,9) months and median leukemia-free survival was 24 (16-31,1) months. In 33 (16%) of the patients, transformation to acute myeloid leukemia was observed in median 8 (1-88) months. 78 (39,2%) of the patients were in low, 77 (38,7%) in intermediate-1, 37 (18,6%) in intermediate-2 and 7 (3,5%) in high IPSS group. And 72 (44,4%) of the patients were in low, 37 (22,8%) in intermediate and 53 (2,7%) in high WPSS group. In 16 (8%) patients CCI score was 0; in 66 (33%) patients 1-2; in 67 (33,5%)patients 3-4; and in 51 ( 25,5%) patients 5 and above. When evaluated in terms of HCT-CI scores, 70 (35%) of the patients were in low, 89 (44,5%) of them in intermediate and 41 (20,5%) of them in high risk group. As IPSS and WPSS risk scores increased, the occurring survival and leukemia-free survival decreased with statistical significance. A similar situation was seen in terms of comorbidity indexes and the progress in CCI and HCT-CI risk groups was related to short survival times with statistical significance. In Cox regression modeling, significant prediction of survival by comorbidity indexes was independent from standard risk scorings (IPSS-WPSS).In the light of the data also put forward by our study, comorbid states of MDS patients at the moment of diagnosis might predict survival. This predicting quality also runs independently from generally-accepted risk scores. Determination of comorbidity indexes at the moment of diagnosis may enable better review of treatment decisions and options.