title: Age and hemoglobin level emerge as most important clinical prognostic parameters in patients with osteomyelofibrosis: introduction of a simplified prognostic score.
abstract: The course of disease in patients with myelofibrosis is highly variable, with survival ranging from few months to many years. Several prognostic models have been established, with the LILLE score now most commonly used. However, in recent series, the latter scoring system repeatedly failed to discriminate patients with intermediate and poor prognosis. In the present study, we re-evaluated previous prognostic models in a separate patient population. We have studied 107 patients with myelofibrosis and correlated clinical parameters at the time of diagnosis with survival. Previous scoring systems were applied to allocate patients to subgroups with distinct prognosis. Most previous scoring systems failed to clearly discriminate an intermediate and poor prognostic group. By contrast, age and hemoglobin level emerged as most significant parameters in multivariate analysis. By allocating one risk point each for hemoglobin < 10 g/dl and age >60 years, three subgroups of patients with distinct prognosis could be identified in our cohort. The overall model and the difference between each of the subgroups were statistically significant in a training group, a test group, the overall cohort of patients and the group of patients with chronic idiopathic myelofibrosis. In summary, we propose an alternative prognostic model for patients with myelofibrosis that reliably identifies three groups of patients with highly different outcome. This is in contrast to previous prognostic scores, in which the poor prognosis group was often very small and/or could not be consistently differentiated from patients with an intermediate prognosis.
authors.affiliation: First Medical Department with Medical Oncology, Wilhelminen Hospital, Vienna, Austria.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Strasser-Weippl
authors.forename: Michael
authors.initials: M
authors.lastname: Steurer
authors.forename: Mathias
authors.initials: M
authors.lastname: Kees
authors.forename: Florian
authors.initials: F
authors.lastname: Augustin
authors.forename: Alexandar
authors.initials: A
authors.lastname: Tzankov
authors.forename: Stephan
authors.initials: S
authors.lastname: Dirnhofer
authors.forename: Michael
authors.initials: M
authors.lastname: Fiegl
authors.forename: Ingrid
authors.initials: I
authors.lastname: Simonitsch-Klupp
authors.forename: Niklas
authors.initials: N
authors.lastname: Zojer
authors.forename: Heinz
authors.initials: H
authors.lastname: Gisslinger
authors.forename: Heinz
authors.initials: H
authors.lastname: Ludwig
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D055728:Primary Myelofibrosis / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis
chemical_list: D006454:Hemoglobins