November 22, 2023
By Johnathan Goodman
A novel prognostic tool may help in stratifying vulnerable patients with myelofibrosis (MF) based on the presence of comorbidities, according to research published in Cancers. However, the authors of the study noted that the tool — the Myelodysplastic Syndrome-Specific Comorbidity Index (MDS-CI) — requires further validation in larger cohorts.
Although clinicians used an established prognostic system for MF that includes blast presence in peripheral blood and genomic abnormalities, comorbidities are also known to affect overall survival (OS) outcomes.
The authors of the present paper designed the MDS-CI, which is based on the Hematopoietic Cell Transplant Comorbidity Index (HCT-CI), to gauge the influence of comorbidities in 4 major organ systems: heart, lung, liver, and kidneys. For this retrospective study, researchers aimed to determine the prognostic potential of the MDS-CI in addition to 2 other scoring systems among patients with MF. They utilized the Dynamic International Prognostic Scoring System (DIPSS) and the Mutation-Enhanced International Prognostic Scoring System (MIPSS)-70.
Overall, data from 70 patients with MF were included, all of whom had not received stem cell transplantation. In the cohort, 51 patients had primary MF whereas 19 had secondary disease. The median follow-up was 40 months.
Initial analysis showed that cardiac disease (23 of 70 patients) and solid tumors (12 of 70) were the most common comorbidities noted at diagnosis.
The MDS-CI effectively predicted survival: a low score (38 patients) was linked with a median OS of 101 months, an intermediate score (25 patients) with a median OS of 50 months, and a high score (7 patients) with a median OS of 8 months (P <.001).
When the authors included the MDS-CI as a categorical variable in a multivariate model with the dichotomized DIPSS or the MIPSS-70, the MDS-CI added prognostic information. This inclusion affected hazard ratios (HRs): a high score was linked with an HR for OS of 14.64 compared with a low-risk score (P = .0002) when included with the DIPSS; a high score was also linked with an HR for OS of 19.65 compared with a low-risk score (P < .001) when included with the MIPSS-70.
“Our observations on the prognostic impact of comorbidities as determined by the MDS-CI in MF confirmed the importance of comorbidities, especially cardiac disease and solid tumors, for the course of the disease and overall survival in MF,” the authors wrote in their report.
Reference
Koster KL, Messerich NM, Volken T, et al. Prognostic significance of the Myelodysplastic Syndrome-Specific Comorbidity Index (MDS-CI) in patients with myelofibrosis: a retrospective study. Cancers (Basel). 2023;15(19):4698. doi:10.3390/cancers15194698