title: Patient-related factors independently impact overall survival in patients with myelodysplastic syndromes: an MDS-CAN prospective study.
abstract: Little is known about the effects of frailty, disability and physical functioning on the clinical outcomes for myelodysplastic syndromes (MDS). We investigated the predictive value of these factors on overall survival (OS) in 445 consecutive patients with MDS and chronic monomyelocytic leukaemia (CMML) enrolled in a multi-centre prospective national registry. Frailty, comorbidity, instrumental activities of daily living, disability, quality of life, fatigue and physical performance measures were evaluated at baseline and were added as covariates to conventional MDS-related factors as predictors of OS in Cox proportional hazards models. The median age was 73 years, and 79% had revised International Prognostic Scoring System (IPSS-R) risk scores of intermediate or lower. Frailty correlated only modestly with comorbidity. OS was significantly shorter for patients with higher frailty and comorbidity scores, any disability, impaired grip strength and timed chair stand tests. By multivariate analysis, the age-adjusted IPSS-R, frailty (Hazard ratio 2·7 (95% confidence interval [CI] 1·7-4·2), P < 0·0001) and Charlson comorbidity score (Hazard ratio 1·8 (95% CI 1·1-2·8), P = 0·01) were independently prognostic of OS. Incorporation of frailty and comorbidity scores improved risk stratification of the IPSS-R by 30% and 5%, respectively. These data demonstrate for the first time, the importance of considering frailty in prognostic models and a potential target for therapeutic intervention in optimizing clinical outcomes in older MDS patients.
  
  
  
  ClinicalTrials.gov Identifier: NCT02537990.
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Rena
authors.initials: R
authors.lastname: Buckstein
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Wells
authors.affiliation: University of Alberta Hospital, Edmonton, AB, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Zhu
authors.affiliation: St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Leitch
authors.affiliation: Vancouver General Hospital, Vancouver, BC, Canada.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Nevill
authors.affiliation: Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Karen W L
authors.initials: KW
authors.lastname: Yee
authors.affiliation: Juravinski Cancer Center, Hamilton Health Sciences Center, Hamilton, ON, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Leber
authors.affiliation: University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Sabloff
authors.affiliation: Centre Hospitalier Universitaire Dr-Georges-L.-Dumont, Moncton, QC, Canada.
authors.forename: Eve
authors.initials: E
authors.lastname: St Hilaire
authors.affiliation: CancerCare Manitoba, Winnipeg, MB, Canada.
authors.forename: Rajat
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Tom Baker Cancer Centre, Calgary, AB, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Geddes
authors.affiliation: Jewish General Hospital, Montreal, QC, Canada.
authors.forename: April
authors.initials: A
authors.lastname: Shamy
authors.affiliation: McGill University, Health Centre-Royal Victoria Hospital, Montreal, QC, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Storring
authors.affiliation: Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Kew
authors.affiliation: Saskatchewan Cancer Agency, Saskatoon, SK, Canada.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elemary
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Max
authors.initials: M
authors.lastname: Levitt
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Martha
authors.initials: M
authors.lastname: Lenis
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Mamedov
authors.affiliation: Macro STAT, Toronto, ON, Canada.
authors.forename: Liying
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada.
authors.forename: Ken
authors.initials: K
authors.lastname: Rockwood
authors.affiliation: Toronto General Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Shabbir M H
authors.initials: SM
authors.lastname: Alibhai
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D015897:Comorbidity; D005260:Female; D016330:Frail Elderly; D006801:Humans; D015477:Leukemia, Myelomonocytic, Chronic / Q000401:mortality; D008297:Male; D009190:Myelodysplastic Syndromes / Q000401:mortality*; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate
keywords: comorbidity; frailty; myelodysplastic syndromes; prognosis; registry