title: Excess mortality in the myelodysplastic syndromes.
abstract: Myelodysplastic syndromes (MDS) are the commonest hematologic malignancies in the elderly. Since many patients with MDS actually die from age-related ailments, the very disease burden of MDS remains largely unknown. This registry-based study was aimed at investigating the excess mortality attributable to MDS. We analyzed 7,408 adult patients diagnosed with primary MDS from 1980 to 2014. Excess mortality was estimated by comparing the patients' survival with that expected in the matched general population. Median age of patients was 74 years, 58% were males, and 65% belonged to the lower risk categories of the Revised International Prognostic Scoring System (IPSS-R). Excess mortality accounted for three-fourths of the all-cause mortality and was mainly driven by factors unrelated to leukemic transformation. Excess mortality increased with the IPSS-R risk category [Incidence rate ratio (IRR): 2.1, 95% CI: 1.9-2.3; P < .001]. Older age and male sex retained an independent association with higher excess mortality after discounting demographic effects. Excess mortality increased in the most recent periods just in the higher risk IPSS-R categories (IRR: 1.2; 95% CI: 1.1-1.3 when comparing periods 2007-14, 2000-06, and 1980-99). In conclusion, MDS carry a significant excess mortality, even in the lower risk categories, that is mainly driven by factors unrelated to leukemic transformation, and increases with older age, male sex, and poorer risk categories. Excess mortality has increased in recent years in the higher risk patients, which might be ascribed to a parallel increase in age-related comorbidities. Our results claim for more comprehensive treatment strategies for patients with MDS. Am. J. Hematol. 92:149-154, 2017. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Hospital Plató, Barcelona, Spain.|Fundació Clínic per la Recerca Biomèdica, Barcelona, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Nomdedeu
authors.affiliation: Hospital Clinic Barcelona, Barcelona, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Pereira
authors.affiliation: Hospital Universitario de León, León, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Ramos
authors.affiliation: Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Valcárcel
authors.affiliation: Hospital Plató, Barcelona, Spain.|Fundació Clínic per la Recerca Biomèdica, Barcelona, Spain.
authors.forename: Dolors
authors.initials: D
authors.lastname: Costa
authors.affiliation: Hospital Durán i Reynals, Institut Català d'Oncologia, Hospitalet de Llobregat, Spain.|Institut d'Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Arnan
authors.affiliation: Hospital del Mar, Barcelona, Spain.|Institut Hospital del Mar d'Investigacions Mèdiques, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Calvo
authors.affiliation: Hospital Durán i Reynals, Institut Català d'Oncologia, Hospitalet de Llobregat, Spain.|Institut d'Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Spain.
authors.forename: Helena
authors.initials: H
authors.lastname: Pomares
authors.affiliation: Hospital Universitario Central Asturias, Oviedo, Spain.
authors.forename: Elisa
authors.initials: E
authors.lastname: Luño
authors.affiliation: Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Díaz-Campelo
authors.affiliation: Hospital General Universitario de Valencia, Valencia, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Collado
authors.affiliation: Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: de Paz
authors.affiliation: Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: José-Francisco
authors.initials: JF
authors.lastname: Falantes
authors.affiliation: Hospital Durán i Reynals, Institut Català d'Oncologia, Hospitalet de Llobregat, Spain.|Institut d'Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Spain.
authors.forename: Carme
authors.initials: C
authors.lastname: Pedro
authors.affiliation: Hospital Doctor Peset, Valencia, Spain.
authors.forename: Josefa
authors.initials: J
authors.lastname: Marco
authors.affiliation: Hospital de Txagorritxu, Vitoria, Spain.
authors.forename: Itziar
authors.initials: I
authors.lastname: Oirtzabal
authors.affiliation: Hospital Universitario Reina Sofía, IMIBIC, Universidad de Córdoba, Córdoba, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Sánchez-García
authors.affiliation: Hospital Clínico Universitario de Valencia, Valencia, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Tormo
authors.affiliation: Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: María-Teresa
authors.initials: MT
authors.lastname: Cedena
authors.affiliation: Fundació Clínic per la Recerca Biomèdica, Barcelona, Spain.|Hospital Clinic Barcelona, Barcelona, Spain.
authors.forename: Benet
authors.initials: B
authors.lastname: Nomdedeu
authors.affiliation: Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Sanz
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009026:Mortality / Q000639:trends; D009190:Myelodysplastic Syndromes / Q000401:mortality*; D011379:Prognosis; D012737:Sex Factors; D013030:Spain; D016019:Survival Analysis