title: Age and comorbidities deeply impact on clinical outcome of patients with myelodysplastic syndromes.
abstract: BACKGROUND
  Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal disorders, with very different prognosis in given individuals; age and comorbidities are emerging as relevant patient-related factors influencing clinical outcome in MDS. Our aim was to evaluate the impact of age, comorbidities and disease severity (IPSS and IPSS-R prognostic scores) in a "real-life" series of MDS patients.
  
  
  METHODS
  318 patients with available assessment of comorbidities at diagnosis and consecutively registered into the Registro Ligure delle Mielodisplasie were analyzed. Comorbidities were evaluated according to HCT-CI and MDS-CI comorbidity indexes. Overall survival (OS) and the probability of death among patients who did not develop acute myeloid leukemia (NLD cumulative incidence) were analyzed.
  
  
  RESULTS
  Comorbidities were seen in 177 (55.7%) patients. An older age (>75 y) had a significant negative impact on OS (p=0.008). HCT-CI was not associated with OS. MDS-CI was of prognostic significance (p=0.001), but the association was limited to pts with IPSS or IPSS-R "lower-risk". In multivariate analysis, MDS-CI remained an independent factor associated with OS and with an increased risk of NLD both when controlling for IPSS (p=0.019 and p=0.001, respectively) and for IPSS-R (p=0.048 and p=0.002, respectively).
  
  
  CONCLUSIONS
  Evaluation of age and comorbidities according to a tailored tool such is MDS-CI helps to predict survival in patients with MDS and should be incorporated to current prognostic scores.
authors.affiliation: Department of Hematology and Oncology, IRCCS AOU San Martino - IST, Largo R. Benzi, 10, 16132 Genova, Italy. Electronic address: balleari@unige.it.
authors.forename: E
authors.initials: E
authors.lastname: Balleari
authors.affiliation: Department of Hematology and Oncology, IRCCS AOU San Martino - IST, Largo R. Benzi, 10, 16132 Genova, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Salvetti
authors.affiliation: Department of Hematology and Oncology, IRCCS AOU San Martino - IST, Largo R. Benzi, 10, 16132 Genova, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Del Corso
authors.affiliation: Clinical Epidemiology, IRCCS AOU San Martino - IST, Largo R. Benzi, 10, 16132 Genova, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Filiberti
authors.affiliation: Department of Hematology and Oncology, IRCCS AOU San Martino - IST, Largo R. Benzi, 10, 16132 Genova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bacigalupo
authors.affiliation: Department of Hematology and Oncology, IRCCS AOU San Martino - IST, Largo R. Benzi, 10, 16132 Genova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bellodi
authors.affiliation: Department of Hematology and Oncology, IRCCS AOU San Martino - IST, Largo R. Benzi, 10, 16132 Genova, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Beltrami
authors.affiliation: Department of Hematology and Oncology, IRCCS AOU San Martino - IST, Largo R. Benzi, 10, 16132 Genova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bergamaschi
authors.affiliation: UO Internal Medicine - ASL 5, Via Cisa 4, 119038 Sarzana, SP, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Berisso
authors.affiliation: UO Internal Medicine - ASL 1, Via Giovanni Borea 56, 18038 Sanremo, IM, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Calzamiglia
authors.affiliation: Department of Hematology and Oncology, IRCCS AOU San Martino - IST, Largo R. Benzi, 10, 16132 Genova, Italy.
authors.forename: A M
authors.initials: AM
authors.lastname: Carella
authors.affiliation: UO Internal Medicine - ASL 4, Via Arnaldo Terzi 43, 16039 Sestri Levante, GE, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cavalleri
authors.affiliation: Department of Hematology and Oncology, IRCCS AOU San Martino - IST, Largo R. Benzi, 10, 16132 Genova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Da Col
authors.affiliation: Department of Hematology and Oncology, IRCCS AOU San Martino - IST, Largo R. Benzi, 10, 16132 Genova, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Favorini
authors.affiliation: UO Hematology - EO Galliera, Mura Delle Cappuccine 14, 16128 Genova, Italy.
authors.forename: G L
authors.initials: GL
authors.lastname: Forni
authors.affiliation: UO Internal Medicine - ASL 2, Via XXV Aprile 38, 17027 Pietra Ligure, SV, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Goretti
authors.affiliation: Department of Hematology and Oncology, IRCCS AOU San Martino - IST, Largo R. Benzi, 10, 16132 Genova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Miglino
authors.affiliation: Department of Hematology and Oncology, IRCCS AOU San Martino - IST, Largo R. Benzi, 10, 16132 Genova, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Mitscheuning
authors.affiliation: Department of Hematology and Oncology, IRCCS AOU San Martino - IST, Largo R. Benzi, 10, 16132 Genova, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Molinari
authors.affiliation: UO Hemato-Oncology - ASL 3, Via Antonio Cantore 3, 16149 Genova, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Racchi
authors.affiliation: UO Internal Medicine - ASL 4, Via Arnaldo Terzi 43, 16039 Sestri Levante, GE, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Scudeletti
authors.affiliation: UO Internal Medicine - ASL 2, Via Genova, 3, 17100 Savona, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Tassara
authors.affiliation: Department of Hematology and Oncology, IRCCS AOU San Martino - IST, Largo R. Benzi, 10, 16132 Genova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Gobbi
authors.affiliation: Department of Hematology and Oncology, IRCCS AOU San Martino - IST, Largo R. Benzi, 10, 16132 Genova, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Lemoli
authors.affiliation: Department of Hematology and Oncology, IRCCS AOU San Martino - IST, Largo R. Benzi, 10, 16132 Genova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Clavio
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Comorbidity; Elderly; Myelodysplastic syndromes; Prognosis