title: Clustering of comorbidities is related to age and sex and impacts clinical outcome in myelodysplastic syndromes.
abstract: OBJECTIVE
  Myelodysplastic syndromes (MDS) are typical diseases of the elderly. The clinical outcome of a well-characterized cohort of patients with MDS was analyzed for prevalence and impact of comorbidities to establish the basis for tailored treatment algorithms. Focus was on age- and sex-related differences.
  
  
  METHODS
  The hematopoietic cell transplantation-comorbidity index (HCT-CI) was assessed in 616 well-defined patients from the Austrian MDS platform (median age: 71years).
  
  
  RESULTS
  Most patients displayed one (24.5%) or more (23.7%) comorbidities. The highest frequencies were observed for cardiovascular disease (28.4%), diabetes (12.2%), and prior tumors (9.9%). Comorbidities were more frequent (mean number: 0.92 vs. 0.74 [male vs. female]; p=0.030) and more severe in men than in women (mean HCT-CI score: 1.41 vs. 1.09 [male vs. female]; p=0.016). Elderly patients (65+years) showed a higher prevalence of comorbidities than younger patients (HCT-CI score: 1.52, mean in 65+, vs. 0.24 and 0.76 in <45years and 46-65years, respectively) (p<0.001). These differences were most pronounced for cardiovascular disease, diabetes, and prior tumors (p<0.001). Presence of cardiac arrhythmia or prior solid tumor was significantly associated with shorter overall survival (p=0.023, 0.024, respectively). Moreover, HCT-CI risk grouping remained an independent prognostic parameter for survival in multivariate analysis.
  
  
  CONCLUSIONS
  Comorbidities impact clinical outcome in elderly patients with MDS. Distinct diseases cluster in an age- and sex-related manner, which may have clinical implications when designing individualized therapies. Comorbidities should be evaluated with established scores and integrated in decision making.
authors.affiliation: Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bammer
authors.affiliation: Department of Internal Medicine I, Division of Hematology and Hemostaseology, Vienna Medical University, Vienna, Austria.
authors.forename: Wolfgang R
authors.initials: WR
authors.lastname: Sperr
authors.affiliation: Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Kemmler
authors.affiliation: Department of Obstetrics and Gynecology, Vienna Medical University, Austria.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Wimazal
authors.affiliation: Third Medical Department for Hematology and Oncology, Hanusch Hospital, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Nösslinger
authors.affiliation: Third Medical Department for Hematology and Oncology, Hanusch Hospital, Vienna, Austria.
authors.forename: Anabel
authors.initials: A
authors.lastname: Schönmetzler
authors.affiliation: Department of Internal Medicine I, Hospital of the Elisabethinen, Linz, Austria.
authors.forename: Otto
authors.initials: O
authors.lastname: Krieger
authors.affiliation: Third Medical Department for Hematology and Oncology, Hanusch Hospital, Vienna, Austria; Ludwig Boltzmann Cluster Oncology, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Pfeilstöcker
authors.affiliation: Third Medical Department for Hematology and Oncology, Hanusch Hospital, Vienna, Austria; Ludwig Boltzmann Cluster Oncology, Vienna, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Valent
authors.affiliation: Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria. Electronic address: reinhard.stauder@i-med.ac.at.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Stauder
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality* / Q000628:therapy; D015995:Prevalence; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D055815:Young Adult
keywords: Age; Assessment; Comorbidities; MDS; Myelodysplastic syndromes; Prognosis; Sex; Survival