The Effect of Chronic Disease on Survival in High-risk Myelodysplastic Syndrome Patients Living in Mersin

Yıl 2019, , 349 - 356, 25.09.2019

Mehmet Ali Uçar

https://doi.org/10.31020/mutftd.593357

Öz

Aim:
Myelodysplastic
syndrome is a clonal stem cell disease of the hematopoietic system.
Myelodysplastic syndrome is a more common disease in men over 65 years of age.
Prognosis is determined by the addition of cytogenetic examination, bone marrow
blast number and degree of cytopenia and the International Prognosis Scoring
System (IPSS). This study was planned to determine the effect of chronic
diseases on survival and prognostic value in patients with high risk
myelodysplastic syndrome.

Method: Between January 2011 and January 2019, patients
diagnosed with MDS in the Hematology outpatient clinic of Mersin University
Medical Faculty were evaluated retrospectively. A total of 124 patients aged
18-96 years, who were present before or at the time of diagnosis of chronic disease,
were diagnosed as MDS by bone marrow biopsy. Categorical variables were
expressed as numbers and percentages. Mortality-related findings were evaluated
by univariable Cox regression analysis.

Results: The mean age of the patients was 67 years.
Cardiac disease, cerebrovascular disease, cancer and chronic obstructive
pulmonary disease were identified as possible risk factors increasing the
mortality risk. It was found that increasing age 1 year increased the risk of
mortality 1.03 times. Those with cardiac disease had a 1.60-fold mortality risk
compared to those without. Those with COPD had a 1.78-fold mortality risk
compared to those without..

Conclusion: Advanced age, cardiac disease,
cerebrovascular disease, cancer and chronic obstructive pulmonary disease were
identified as possible risk factors that increased mortality. This study is
important because it is the first study with the highest number of patients
with single center in Mersin region on MDS. However, we think that these data
will shed light on the effect of the presence of chronic disease on mortality
and the most appropriate treatment options in MDS patients living in Mersin.

Anahtar Kelimeler

Myelodysplastic syndrome, chronic disease, prognosis

Mersin Bölgesinde Yaşayan Yüksek Riskli Myelodisplastik Sendrom Hastalarında Kronik Hastalık Varlığının Sağ Kalım Üzerine Etkisi

Öz

Amaç: Myelodisplastik sendrom hematopoetik sistemin klonal kök hücre
hastalığıdır. Myelodisplastik sendrom, 65 yaş üzerinde erkeklerde daha sık
görülen bir hastalıktır. Prognoz tayininde sitogenetik inceleme, kemik
iliğindeki blast sayısı ve sitopeninin derecesinin eklenmesi ile Uluslarası
Prognoz Puanlama Sistemi (IPSS) kullanılır.  Yüksek riskli myelodisplastik sendrom
hastalarında kronik hastalıkların sağ kalım üzerine etkisi ve prognostik
değerini tespit etmek üzere bu çalışma planlandı.

Yöntem: 2011 ocak ve 2019 ocak yılları arasında Mersin Üniversitesi Tıp
Fakültesi Hematoloji polikliniğinde MDS tanılı hastalar retrospektif olarak
değerlendirildi. 18-96 yaş arası, kronik hastalık varlığı tanı anında veya
öncesinde mevcut olan, kemik iliği biyopsisi ile MDS tanısı konan 124 hasta
çalışmaya alındı. Kategorik değişkenler sayı ve yüzde olarak belirtildi.
Mortalite ile ilişkili bulgular univariable Cox regression analiz ile
değerlendirildi.

Bulgular: Hastaların ortalama yaşı 67 yıldı. Kardiyak hastalık, serebrovasküler
hastalık, kanser ve kronik obstruktif akciğer hastalığı mortalite riskini
arttıran olası risk faktörleri olarak saptandı. Yaşın 1 yıl artması 1,03 kat
mortalite riskini arttırdığı saptandı. Kardiyak hastalığı olanlar olmayanlara
kıyasla 1,60 kat mortalite riskine sahipti. KOAH olanlar olmayanlara kıyasla
1,78 kat mortalite riskini sahipti.

Sonuç: İleri yaş, kardiyak hastalık, serebrovasküler hastalık, kanser ve
kronik obstruktif akciğer hastalığı mortalite riskini arttıran olası risk
faktörleri olarak saptandı. Bu çalışma MDS üzerine Mersin bölgesinden yapılmış
tek merkezli en fazla hasta sayısına sahip olan ilk çalışma olması nedeni ile
önemlidir. Bununla birlikte elde ettiğimiz bu verilerin Mersin’de yaşayan MDS
hastalarında kronik hastalık varlığının mortaliteye etkisi ve en uygun tedavi
seçeneklerini belirlemeye ışık tutacağını düşünmekteyiz. 

Anahtar Kelimeler

myelodisplastik sendrom, kronik hastalık

Kaynakça

• 1. Rollison, D. E. et al. 2008. Epidemiology of myelodysplastic syndromes and chronic myeloproliferative disorders in the United States, 2001-2004, using data from the NAACCR and SEER programs', Blood, 112: 45-52.
• 2. Ma X, Does M, Raza A, Mayne ST. Myelodysplastic syndromes: incidence and survival in the United States. Cancer. 2007;109(8):1536.
• 3. Tricot G et al. Prognostic factors in the myelodysplastic syndromes: importance of initial data on peripheral blood counts, bone marrow cytology, trephine biopsy and chromosomal analysis. Br J Haematol. 1985;60(1):19.
• 4. Jacobs RH et al. Prognostic implications of morphology and karyotype in primary myelodysplastic syndromes. JD. Blood. 1986;67(6):1765.
• 5. Greenberg P. et al. International scoring system for evaluating prognosis in myelodysplastic syndromes. J. Blood. 1997;89(6):2079.
• 6. Greenberg PL at al. Revised international prognostic scoring system for myelodysplastic syndromes. Blood. 2012;120(12):2454. Epub 2012 Jun 27.
• 7. Sperr WR et al. 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(1):114. Epub 2009 Jul 15.
• 8. Sanz GF, Sanz MA, Vallespi T et al. Two regression models and a scoring system. for predicting survival and planning treatment in myelodysplastic syndromes. A multivariate analysis of prognostic factors in 370 patients. Blood 1989; 74: 395–408
• 9. Malcovati L, Porta MG, Pascutto C et al. Prognostic factors and life expectancy in myelodysplastic syndromes classified according to WHO criteria: a basis for clinical decision making. J Clin Oncol 2005; 23: 7594–7603.
• 10. Sorror ML, Sandmaier BM, Storer BE et al. Comorbidity and disease status based risk stratification of outcomes among patients with acute myeloid leukemia or myelodysplasia receiving allogeneic hematopoietic cell transplantation. J Clin Oncol 2007; 25: 4246–4254.
• 11. Arber DA et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016 May 19;127(20):2391 405. doi: 10.1182/blood-2016-03-643544. Epub 2016 Apr 11.
• 12. Breccia M et al. Evaluation of comorbidities at diagnosis predicts outcome in myelodysplastic syndrome patients. Leuk Res. 2011;35(2):159.
• 13. Della Porta MG et al. Risk stratification based on both disease status and extra-hematologic comorbidities in patients with myelodysplastic syndrome. Haematologica. 2011;96(3):441. Epub 2010 Dec 6.
• 14. Naqvi K, et al. Association of comorbidities with overall survival in myelodysplastic syndrome: development of a prognostic model. J Clin Oncol. 2011;29(16):2240. Epub 2011 May 2.
• 15. Etienne A, et al. Comorbidity is an independent predictor of complete remission in elderly patients receiving induction chemotherapy for acute myeloid leukemia. Cancer 2007; 109: 1376–1383.
• 16. Pfeilstocker M et al: Myelodysplastic syndromes, aging, and age: Correlations, common mechanisms, and clinical implications. Leuk Lymphoma 48:1900-1909, 2007
• 17. Wang R, et al: Comorbidities and survival in a large cohort of patients with newly diagnosed myelodysplastic syndromes. Leuk. Res 33:1594-1598, 2009
• 18. Boogaerts MA, Verhoef GEG, Demutynk H. Treatment and prognostic factors in myelodysplasic syndromes. Baillie´ res Clin Haematol 1996; 9: 161–183.
• 19. Tefferi A, Vardiman JW. Myelodysplastic syndromes. N Engl J Med 2009;361:1872–85.