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. 2010 May 1;116(9):2174-9.
doi: 10.1002/cncr.24984.

Cause of death in patients with lower-risk myelodysplastic syndrome

Farshid Dayyani  1 , Anthony P Conley, Sara S Strom, William Stevenson, Jorge E Cortes, Gautam Borthakur, Stefan Faderl, Susan O'Brien, Sherry Pierce, Hagop Kantarjian, Guillermo Garcia-Manero
Affiliations

Cause of death in patients with lower-risk myelodysplastic syndrome

Farshid Dayyani et al. Cancer. .

Abstract

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.

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Figures

Figure 1
Figure 1
(A) Of 273 patients with a known cause of death (COD), 230 (84%) died of myelodysplastic syndrome (MDS)-related causes versus 43 (16%) patients who died of unrelated causes. (B) Among patients with a known COD related to MDS (n = 230), the majority (n = 104) died of infections, followed by transformation to acute myelogenous leukemia (AML)(n = 40) and hemorrhage (n = 35).
Figure 2
Figure 2
Distribution of cause of death by decade is shown. P values shown are for the decade of the 2000s compared with previous decades.
Figure 3
Figure 3
Survival is shown by decade. OS indicates overall survival.
See this image and copyright information in PMC

Comment in

References

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