Abstract
Objectives
The International Prognostic Scoring System (IPSS) is commonly used to predict survival
and assign treatment for the myelodysplastic syndromes (MDS). We explored whether
self-reported and readily available non-hematologic predictors of survival add independent
prognostic information to the IPSS.
Materials and Methods
Retrospective cohort study of consecutive MDS patients ≥age 65 who presented to Dana-Farber Cancer Institute between 2006 and 2011 and completed
a baseline quality of life questionnaire. Questions corresponding to functional status
and symptoms and extracted clinical-pathologic data from medical records. Kaplan–Meier
and Cox proportional hazards models were used to estimate survival.
Results
One hundred fourteen patients consented and were available for analysis. Median age
was 73 years, and the majority of patients were White, were male, and had a Charlson comorbidity
score of <2. Few patients (24%) had an IPSS score consistent with lower-risk disease and the
majority received chemotherapy. In addition to IPSS score and history of prior chemotherapy
or radiation, significant univariate predictors of survival included low serum albumin,
Charlson score, performance status, ability to take a long walk, and interference
of physical symptoms in family life. The multivariate model that best predicted mortality
included low serum albumin (HR = 2.3; 95% CI: 1.06–5.14), therapy-related MDS (HR = 2.1; 95% CI: 1.16–4.24), IPSS score (HR = 1.7; 95% CI: 1.14–2.49), and ease taking a long walk (HR = 0.44; 95% CI: 0.23–0.90).
Conclusions
In this study of older adults with MDS, we found that low serum albumin and physical
function added important prognostic information to the IPSS score. Self-reported physical
function was more predictive than physician-assigned performance status.
Keywords
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References
- The 2030 problem: caring for aging baby boomers.Health Serv Res. 2002; 37: 849-884
- The challenge of individualised risk assessment and therapy planning in elderly high-risk myelodysplastic syndromes (MDS) patients.Ann Hematol. 2012; 1: 1
- Optimal positioning of hematopoietic stem cell transplantation for older patients with myelodysplastic syndromes.Curr Opin Hematol. 2013; 20: 150-156
- International scoring system for evaluating prognosis in myelodysplastic syndromes.Blood. 1997; 89: 2079-2088
- Revised international prognostic scoring system for myelodysplastic syndromes.Blood. 2012; 120: 2454-2465
- Validation of a prognostic model and the impact of mutations in patients with lower-risk myelodysplastic syndromes.J Clin Oncol. 2012; 30: 3376-3382
- Refinement of the international prognostic scoring system (IPSS) by including LDH as an additional prognostic variable to improve risk assessment in patients with primary myelodysplastic syndromes (MDS).Leukemia. 2005; 19: 2223-2231
- Proposal for a new risk model in myelodysplastic syndrome that accounts for events not considered in the original International Prognostic Scoring System.Cancer. 2008; 113: 1351-1361
- Update on cytogenetic and molecular changes in myelodysplastic syndromes.Leuk Lymphoma. 2012; 53: 525-536
- Frailty in older adults: evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
- Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study.J Am Geriatr Soc. 2005; 53: 1321-1330
- The relevance of a geriatric assessment for elderly patients with a haematological malignancy - a systematic review.Leuk Res. 2014; 38: 275-283
- A comprehensive geriatric assessment is more effective than clinical judgment to identify elderly diffuse large cell lymphoma patients who benefit from aggressive therapy.Cancer. 2009; 115: 4547-4553
- Geriatric assessment is associated with completion of chemotherapy, toxicity, and survival in older adults with cancer.J geriatr oncol. 2013; 4: 227-234
- Geriatric assessment predicts survival for older adults receiving induction chemotherapy for acute myelogenous leukemia.Blood. 2013; 121: 4287-4294
- The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.J Natl Cancer Inst. 1993; 85: 365-376
- The EORTC QLQ-C30 scoring manual.3rd edition. European Organisation for Research and Treatment of Cancer, Brussels2001
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Report of an international working group to standardize response criteria for myelodysplastic syndromes.Blood. 2000; 96: 3671-3674
- The impact of age on the diagnosis and therapy of myelodysplastic syndromes: results from a retrospective multicenter analysis in Germany.Eur J Haematol. 2013; 91: 473-482
- Senior adult oncology.J Natl Compr Canc Netw. 2012; 10: 162-209
- Comprehensive geriatric assessment for older patients with cancer.J Clin Oncol. 2007; 25: 1824-1831
- Evaluating the older patient with cancer: understanding frailty and the geriatric assessment.CA Cancer J Clin. 2010; 60: 120-132
- A practical approach to geriatric assessment in oncology.J Clin Oncol. 2007; 25: 1936-1944
- NCCN clinical practice guidelines in oncology: myelodysplastic syndromes.J Natl Compr Canc Netw. 2011; 9: 30-56
- The influence of clinical assessment (including age) and geriatric assessment on treatment decisions in older patients with cancer.J Geriatr Oncol. 2013; 4: 235-241
- Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study.Ann Oncol. 2005; 16: 1795-1800
- Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study.J Clin Oncol. 2011; 29: 3636-3642
- Geriatric assessment improves prediction of surgical outcomes in older adults undergoing pancreaticoduodenectomy: a prospective cohort study.Ann Surg. 2014; 259: 960-965
- Basic assessment of the older cancer patient.Curr Treat Options Oncol. 2011; 12: 276-285
- The feasibility of inpatient geriatric assessment for older adults receiving induction chemotherapy for acute myelogenous leukemia.J Am Geriatr Soc. 2011; 59: 1837-1846
- Parameters detected by geriatric and quality of life assessment in 195 older patients with myelodysplastic syndromes and acute myeloid leukemia are highly predictive for outcome.Haematologica. 2013; 98: 208-216
- Prognostic significance of potential frailty criteria.J Am Geriatr Soc. 2008; 56: 2211-2216
- Gait speed and survival in older adults.JAMA. 2011; 305: 50-58
- Older breast cancer survivors: geriatric assessment domains are associated with poor tolerance of treatment adverse effects and predict mortality over 7 years of follow-up.J Clin Oncol. 2010; 28: 380-386
- Using reference data on quality of life—the importance of adjusting for age and gender, exemplified by the EORTC QLQ-C30 (+3).Eur J Cancer. 1998; 34: 1381-1389
- Identifying vulnerable older adults with cancer: integrating geriatric assessment into oncology practice.J Am Geriatr Soc. 2007; 55: 1604-1608
- Geriatric assessment in older patients with acute myeloid leukemia: a retrospective study of associated treatment and outcomes.Leuk Res. 2013; 37: 998-1003
- Risk stratification based on both disease status and extra-hematologic comorbidities in patients with myelodysplastic syndrome.Haematologica. 2011; 96: 441-449
- 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.Ann Oncol. 2010; 21: 114-119
Article info
Publication history
Published online: June 11, 2015
Accepted:
May 27,
2015
Received in revised form:
March 4,
2015
Received:
December 4,
2014
Footnotes
†This paper was presented in abstract form at the AGS Annual Meeting, Grapevine, Texas, May 2–6, 2013.
Identification
Copyright
Published by Elsevier Inc.
