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Annals of Oncology Advance Access published online on July 15, 2009
Annals of Oncology, doi:10.1093/annonc/mdp258
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Comorbidity as prognostic variable in MDS: comparative evaluation of the HCT-CI and CCI in a core dataset of 419 patients of the Austrian MDS Study Group

W. R. Sperr1,*, F. Wimazal1, M. Kundi2, C. Baumgartner1, T. Nösslinger3, A. Makrai3, R. Stauder4, O. Krieger5, M. Pfeilstöcker1,6 and P. Valent1,6

1 Department of Internal Medicine I, Division of Hematology and Hemostaseology
2 Institute of Environmental Health, Medical University of Vienna, Vienna
3 Third Medical Department for Hematology and Oncology, Hanusch Hospital, Vienna
4 Department of Internal Medicine V, Haematology and Oncology, Medical University of Innsbruck, Innsbruck
5 Department of Internal Medicine I, Hospital of the Elisabethinen, Linz
6 Ludwig Boltzmann Cluster Oncology, Vienna, Austria

* Correspondence to: Dr W. R. Sperr, Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, A-1090 Vienna, Austria. Tel: +43-1-40400-6085; Fax: +43-1-40400-4030; E-mail: wolfgang.r.sperr{at}meduniwien.ac.at

Background: The evaluation of comorbidity is of increasing importance in patients with hematologic disorders.

Patients and methods: In the present study, the influence of comorbidity on survival and acute myeloid leukemia (AML) evolution was analyzed retrospectively in 419 patients with de novo myelodysplastic syndromes (MDS) (observation period: 1985–2007). The median age was 71 years (range 24–91 years). Two different scoring systems, the hematopoietic stem-cell transplantation-specific comorbidity index (HCT-CI) and the Charlson comorbidity index (CCI) were applied.

Results: The HCT-CI was found to be a significant prognostic factor for overall survival (OS, P < 0.05) as well as event-free survival (EFS, P < 0.05) in our patients, whereas the CCI was of prognostic significance for OS (P < 0.05), but not for EFS. For AML-free survival, neither the HCT-CI nor the CCI were of predictive value. A multivariate analysis including age, lactate dehydrogenase, ferritin, karyotype, number of cytopenias, French–American–British groups, and comorbidity was applied. Comorbidity was found to be an independent prognostic factor in patients with low- or int-1-risk MDS (P < 0.05) regarding OS and EFS.

Conclusions: Together, our data show that comorbidity is an important risk factor for OS and EFS in patients with MDS.

comorbidity, MDS, prognostication, survival

Received for publication October 27, 2008. Revision received March 30, 2009. Accepted for publication April 1, 2009.


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