Cause of death in patients with lower‐risk myelodysplastic syndrome

BACKGROUND: The authors have recently shown that a majority of patients with myelodysplastic syndrome (MDS) classified by the International Prognostic Scoring System as lower risk die without transformation to acute myelogenous leukemia (AML). The cause of death (COD) of these patients is not well u...

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Published in:Cancer 2010-05, Vol.116 (9), p.2174-2179
Main Authors: Dayyani, Farshid, Conley, Anthony P., Strom, Sara S., Stevenson, William, Cortes, Jorge E., Borthakur, Gautam, Faderl, Stefan, O'Brien, Susan, Pierce, Sherry, Kantarjian, Hagop, Garcia‐Manero, Guillermo
Format: Article
Language:English
Subjects:
Adult
Age
Aged
Aged, 80 and over
Biological and medical sciences
Cancer
Cause of Death
Chemical oxygen demand
Classification
Disease Progression
Female
Hematologic and hematopoietic diseases
Hemorrhage - complications
Humans
Infection
Infection - complications
International Prognostic Scoring System
Intervention
Leukemia
Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis
Male
Medical sciences
Middle Aged
Mortality
myelodysplastic syndrome
Myelodysplastic Syndromes - mortality
Prognosis
Risk
Survival
Tumors
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Summary:BACKGROUND: The authors have recently shown that a majority of patients with myelodysplastic syndrome (MDS) classified by the International Prognostic Scoring System as lower risk die without transformation to acute myelogenous leukemia (AML). The cause of death (COD) of these patients is not well understood. Identifying the COD could help to guide early therapy decisions. METHODS: The authors retrospectively analyzed the COD in a cohort of 273 deceased patients with lower‐risk MDS according to the International Prognostic Scoring System at presentation to The University of Texas M. D. Anderson Cancer Center from 1980 to 2004. MDS‐related death was defined as infection, bleeding, transformation to AML, or disease progression. Remaining CODs were classified as non–MDS‐related. RESULTS: Median age at presentation was 66 years (range, 19‐88 years). Overall median survival was 59 weeks (range, 1‐831 weeks). All French‐American‐British leukemia classification subgroups were represented. The percentage of International Prognostic Scoring System low and intermediate‐1 groups were 21% and 79%, respectively. The most common cytogenetic abnormality (9%) was del(5q). Patients received supportive care only. The COD was identified as MDS‐related in 230 of 273 (84%) patients. The most common disease‐related CODs were infection (38%), transformation to AML (15%), and hemorrhage (13%). The most frequent non–disease‐related COD was cardiovascular events (19 of 43 patients). CONCLUSIONS: The majority of patients with low‐ or intermediate‐1 risk MDS will die because of causes related to their underlying disease. Although these results need to be validated in different populations, early therapeutic intervention could be considered in the management of these patients to improve survival. Cancer 2010. © 2010 American Cancer Society. The cause of death in the majority of patients with lower‐risk myelodysplastic syndrome is related to their underlying condition. Therefore, the benefit of earlier therapeutic intervention in this patient cohort should be further investigated.
ISSN:0008-543X
1097-0142
1097-0142
DOI:10.1002/cncr.24984