Causes of death in 2877 patients with myelodysplastic syndromes

Abstract

Patients with myelodysplastic syndromes face a poor prognosis. The exact causes of death have not been described properly in the past. We performed a retrospective analysis of causes of death using data of 3792 patients in the Düsseldorf registry who have been followed up for a median time of 21 months. Medical files as well as death certificates were screened and primary care physicians were contacted. Death after AML evolution, infection, and bleeding was considered to be clearly disease-related. Further categories of causes of death were heart failure, other possibly disease-related reasons, such as hemochromatosis, disease-independent reasons as well as cases with unclear causes of death. Median age at the time of diagnosis was 71 years. At the time of analysis, 2877 patients (75.9 %) had deceased. In 1212 cases (42.1 %), the exact cause of death could not be ascertained. From 1665 patients with a clearly documented cause of death, 1388 patients (83.4 %) succumbed directly disease-related (AML (46.6 %), infection (27.0 %), bleeding (9.8 %)), whereas 277 patients (16.6 %) died for reasons not directly related with myelodysplastic syndromes (MDS), including 132 patients with cardiac failure, 77 non-disease-related reasons, 23 patients with solid tumors, and 45 patients with possibly disease-related causes like hemochromatosis. Correlation with IPSS, IPSS-R, and WPSS categories showed a proportional increase of disease-related causes of death with increasing IPSS/IPSS-R/WPSS risk category. Likewise, therapy-related MDS were associated with a higher percentage of disease-related causes of death than primary MDS. This reflects the increasing influence of the underlying disease on the cause of death with increasing aggressiveness of the disease.

Risk and timing of cardiovascular death among patients with myelodysplastic syndromes

“…[29][30][31][32][33][34] Previous analyses have considered cohorts of patients with varying follow-up that may not account for timedependent risks in MDS. Moreover, referral patterns may bias outcomes due to patient selection for those with higher-risk disease, particularly within larger referral hospitals.…”

Antiplatelet Therapy in a Patient with Coronary Artery Disease and Myelodysplastic Syndrome with Thrombocytopenia

“…For example, patients with primary immune thrombocytopenia have younger circulating platelets and, consequently, less severe bleeding symptoms than patients with a similar degree of thrombocytopenia due to bone marrow failure, whose platelets tend to be older and hypoactive (1,3). Platelets in myelodysplastic syndromes often express abnormally low levels of procoagulant cell surface markers or lack intracellular granules, which exacerbates bleeding from thrombocytopenia (4)(5)(6).…”

“…Likewise, in patients with thrombocytopenia, the risk of bleeding varies and may depend upon the underlying cause (1,2). Platelets in myelodysplastic syndromes are dysfunctional (3) and, after leukemic transformation and infection, bleeding is the next most common cause of death (4)(5)(6). On the other hand, thrombocytopenia itself is not protective and acute coronary syndromes have been reported in patients who have thrombocytopenia that is associated with various disorders (7)(8)(9).…”

The incidence, risk factors, and survival of acute myeloid leukemia secondary to myelodysplastic syndrome: A population‐based study

“…sAML is unique from de novo AML and is associated with a poorer response to induction chemotherapy and decreased survival . Recent analyses of two European registries have indicated that sAML causes one‐third to one‐half of disease‐related deaths among patients with MDS …”