title: Comorbidities predict worse prognosis in patients with primary myelofibrosis.
abstract: BACKGROUND
  Comorbidities have been shown to play an important role in the prognostic assessment of several hematologic conditions; however, the role of comorbidities in primary myelofibrosis has not been studied. The objective of the current study was to evaluate the prevalence and impact of comorbidities in patients with primary myelofibrosis (PMF) using the Adult Comorbidity Evaluation-27 (ACE-27).
  
  
  METHODS
  In this retrospective observational cohort study, a total of 349 consecutive patients with a confirmed diagnosis of PMF who presented to the study institution from 2000 to 2008 were evaluated. The authors evaluated the frequency and severity of comorbidities in these patients and assessed their impact on survival in a bivariable model that included the ACE-27 and Dynamic International Prognostic Scoring System scores as covariates.
  
  
  RESULTS
  Approximately 64% of patients had at least 1 comorbid condition, and diseases of the cardiovascular system (63%) were most common. Comorbidities had a significant negative impact on survival (P < .001). Patients with severe comorbidities had twice the risk of death as those with no comorbidities. When stratified by demographic and clinical characteristics, comorbidities were found to be significantly associated with worse survival in patients aged < 65 years (P < .001) and those with an ECOG performance status < 1 (P < .001). In a multivariable model that included the ACE-27 and Dynamic International Prognostic Scoring System scores, comorbidities retained a significant association with shorter survival (P ≤ .001).
  
  
  CONCLUSIONS
  The assessment of comorbid conditions in patients with PMF, particularly those who are younger and with a good performance status, has important implications for overall prognosis and treatment planning.
authors.affiliation: Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Kate J
authors.initials: KJ
authors.lastname: Newberry
authors.forename: Kiran
authors.initials: K
authors.lastname: Naqvi
authors.forename: Khanh T
authors.initials: KT
authors.lastname: Nguyen
authors.forename: Marylou
authors.initials: M
authors.lastname: Cardenas-Turanzas
authors.forename: Maria
authors.initials: M
authors.lastname: Florencia Tanaka
authors.forename: Sherry
authors.initials: S
authors.lastname: Pierce
authors.forename: Srdan
authors.initials: S
authors.lastname: Verstovsek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D004700:Endocrine System Diseases / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D055728:Primary Myelofibrosis / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: Adult Comorbidity Evaluation-27 score; Dynamic International Prognostic Scoring System score; comorbidity; primary myelofibrosis; prognosis