Association of comorbidities with overall survival in myelodysplastic syndrome: Development of a prognostic model

Kiran Naqvi, Guillermo Garcia-Manero*, Sagar Sardesai, Jeong Oh, Carlos E. Vigil, Sherry Pierce, Xiudong Lei, Jianqin Shan, Hagop M. Kantarjian, Maria E. Suarez-Almazor

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

119 Scopus citations


Purpose: Patients with cancer often experience comorbidities that may affect their prognosis and outcome. The objective of this study was to determine the effect of comorbidities on the survival of patients with myelodysplastic syndrome (MDS). Patients and Methods: We conducted a retrospective cohort study of 600 consecutive patients with MDS who presented to MD Anderson Cancer Center from January 2002 to December 2004. The Adult Comorbidity Evaluation-27 (ACE-27) scale was used to assess comorbidities. Data on demographics, International Prognostic Scoring System (IPSS), treatment, and outcome (leukemic transformation and survival) were collected. Kaplan-Meier methods and Cox regression were used to assess survival. A prognostic model incorporating baseline comorbidities with age and IPSS was developed to predict survival. Results: Overall median survival was 18.6 months. According to the ACE-27 categories, median survival was 31.8, 16.8, 15.2, and 9.7 months for those with none, mild, moderate, and severe comorbidities, respectively (P < .001). Adjusted hazard ratios were 1.3, 1.6, and 2.3 for mild, moderate, and severe comorbidities, respectively, compared with no comorbidities (P < .001). A final pognostic model including age, IPSS, and comorbidity score predicted median survival of 43.0, 23.0, and 9.0 months for lower-, intermediate-, and high-risk groups, respectively (P < .001). Conclusion: Comorbidities have a significant impact on the survival of patients with MDS. Patients with severe comorbidity had a 50% decrease in survival, independent of age and IPSS risk group. A comprehensive assessment of the severity of comorbidities helps predict survival in patients with MDS.

Original languageEnglish (US)
Pages (from-to)2240-2246
Number of pages7
JournalJournal of Clinical Oncology
Issue number16
StatePublished - Jun 1 2011
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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