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

Abstract

Population-based studies that contain detailed clinical data on patients with myelodysplastic syndrome (MDS) are scarce. This study focused on the real-world overall survival (OS) of MDS patients in association with comorbidities, specifically malignancies. An observational population-based study using the HemoBase registry was performed, including all patients with MDS diagnosed between 2005 and 2017 in Friesland, a Dutch province. Detailed information about diagnosis, patient characteristics, previous treatment of malignancies, and comorbidities according to the Charlson Comorbidity Index (CCI) was collected from electronic health records. Patients were followed up until June 2019. Kaplan-Meier plots and Cox regression analyses were used to study survival differences. In the 291 patients diagnosed with MDS, the median OS was 25.3 months (95% confidence interval [CI], 20.3-30.2). OS was significantly better for patients with CCI score <4, age <65 years, female sex, and low-risk MDS. Fifty-seven patients (20%) had encountered a prior malignancy (excluding nonmelanoma skin cancer), and a majority (38 patients; 67%) were therapy related. Both therapy-related and secondary MDSs were associated with worse OS (hazard ratio, 1.51; 95% CI, 1.02-2.23 and 1.58; 95% CI, 0.95-2.65, respectively), as compared with de novo MDS patients (P = .04). Patients in remission at time of MDS diagnosis had a similar median OS compared with patients with de novo MDS (25.5 vs 28.3 months). This population-based study involving all newly diagnosed MDS patients over a 13-year period in Friesland showed that multiple comorbidities, including previous malignancies, are associated with shorter OS. OS was not related to the use of radiotherapy or chemotherapy.

Increased prescription rate of anti‐infective agents after diagnosis of myelodysplastic syndromes

“…All persons newly diagnosed with MDS between January 1, 2005 and December 31, 2017 were included in the study and followed through December 31, 2020 (also see Supplementary Data) [2].…”

“…A retrospective, population‐based study was performed using the HemoBase registry [ 2 , 20 , 21 ]. The local Medical Ethics Committee confirmed the execution of the study without the need for ethical review.…”

“…Myelodysplastic syndromes (MDS) are a group of clonal bone marrow disorders [ 1 ]. MDS is predominantly a disease of the elderly, with a median age at diagnosis of 75 years and a high prevalence of comorbidities [ 2 , 3 ]. Many MDS patients suffer from neutropenia and/or neutrophil dysfunction; therefore the risk for infections is of particular interest [ 4 , 5 ].…”

“…The HemoBase registry offers the means to assess the prescription of anti‐infective agents in MDS patients in Friesland, a province in the Netherlands with ±650,000 inhabitants. This registry includes all hemato‐oncological patients diagnosed since 2005 and provides population‐based data on diagnosis, treatment, and the day‐to‐day practice of MDS patients [ 2 , 20 ]. Combined with first‐line care data, it offers a unique view on how these patients are treated.…”

Management of infection prophylaxis in Dutch patients with myelodysplastic syndromes, a web‐based case vignette questionnaire: The MINDSET study

“…These vulnerable patients often suffer from comorbidities. [3][4][5][6] MDS is characterised by ineffective haematopoiesis, resulting in cytopenia and dysplasia, and has been associated with an increased risk of infections. 1,2,[7][8][9][10][11] Infections have been found to be a significant cause of death among MDS patients.…”