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The impact of anaemia, transfusion dependency, comorbidities and polypharmacy in elderly patients with low-risk myelodysplastic syndromes

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Abstract

Myelodysplastic syndromes (MDS) are heterogeneous clonal disorders ranging from indolent conditions with a near-normal life expectancy to forms approaching acute myeloid leukaemia. Comorbid conditions have rarely been systematically studied among patients with MDS. Older age per se has a negative impact on survival of MDS patients, in particular of those with lower risk. However, age indirectly affects also the survival of higher-risk patients by limiting their eligibility to intensive treatments. In addition, ageing is associated with an increasingly high risk of developing comorbidity, and a high prevalence of comorbid diseases has indeed been reported in MDS patients. The impact of multi-morbidities/comorbidities and polypharmacy in patients with low-risk MDS patients is a poorly explored topic. We focused on medications, multi-morbidities and comorbidities of 155 low-risk MDS patients followed in the haematological outpatients clinics or in medical/oncology wards of our University Hospital. One or more comorbidities were present at diagnosis in 24 younger patients with MDS syndromes (31%), whereas 56 older patients with MDS (75%) presented 1 or more comorbidities (P < 0.001).The most frequent comorbidity was cardiac comorbidity 18% in younger patients and 25% in older patients. With no statistical significance between older and younger patients, congestive heart failure was the most frequent observed disease. Our study has shown a statistical correlation between transfusion dependency and polypathology (P = 0.0014). These data were also confirmed in a subanalysis of the younger group of patients. Our study has shown that comorbidity is very common among patients with MDS, potentially affecting the clinical course and outcome of MDS patients.

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References

  1. Neukirchen J, Schoonen WM, Strupp C, et al. Incidence and prevalence of myelodysplastic syndromes: data from the Düsseldorf MDS-registry. Leuk Res. 2011;35(12):1591–6. https://doi.org/10.1016/j.leukres.2011.06.001.

    Article  PubMed  Google Scholar 

  2. Santini V. First-line therapeutic strategies for myelodysplastic syndromes. Clin Lymphoma Myeloma Leuk. 2017;17S:S31–6. https://doi.org/10.1016/j.clml.2017.02.013.

    Article  PubMed  Google Scholar 

  3. Uy N, Singh A, Gore SD, Prebet T. Hypomethylating agents (HMA) treatment for myelodysplastic syndromes: alternatives in the frontline and relapse settings. Expert Opin Pharmacother. 2017;18(12):1213–24. https://doi.org/10.1080/14656566.2017.1349100.

    Article  CAS  PubMed  Google Scholar 

  4. Castelli R, Deliliers GL, Colombo R, Moreo G, Gallipoli P, Pantaleo G. Biosimilar epoetin in elderly patients with low-risk myelodysplastic syndromes improves anemia, quality of life, and brain function. Ann Hematol. 2014. https://doi.org/10.1007/s00277-014-2070-8.

    PubMed  Google Scholar 

  5. Castelli R, Cassin R, Cannavò A, Cugno M. Immunomodulatory drugs: new options for the treatment of myelodysplastic syndromes. Clin Lymphoma Myeloma Leuk. 2013;13(1):1–7. https://doi.org/10.1016/j.clml.2012.09.016.

    Article  CAS  PubMed  Google Scholar 

  6. Platzbecker U, Symeonidis A, Oliva EN, et al. A phase 3 randomized placebo-controlled trial of darbepoetin alfa in patients with anemia and lower-risk myelodysplastic syndromes. Leukemia. 2017;31(9):1944–50. https://doi.org/10.1038/leu.2017.192.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Rosti G, Petrini M, Bosi A, et al. Management of anaemia in oncohaematological patients treated with biosimilar epoetin alfa: results of an Italian observational, retrospective study. Ther Adv Med Oncol. 2017. https://doi.org/10.1177/1758834016670554.

    PubMed  Google Scholar 

  8. Gidaro A, Deliliers GL, Gallipoli P, Arquati M, Wu MA, Castelli R. Laboratory and clinical risk assessment to treat myelodysplatic syndromes. Clin Chem Lab Med. 2016;54(9):1411–26. https://doi.org/10.1515/cclm-2015-0789.

    Google Scholar 

  9. Della Porta MG, Malcovati L. Clinical relevance of extra-hematologic comorbidity in the management of patients with myelodysplastic syndrome. Haematologica. 2009;94(5):602–6. https://doi.org/10.3324/haematol.2009.005702.

    Article  PubMed  Google Scholar 

  10. Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009;7(4):357–63. https://doi.org/10.1370/afm.983.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Mannucci PM, Nobili A, REPOSI Investigators. Multimorbidity and polypharmacy in the elderly: lessons from REPOSI. Intern Emerg Med. 2014;9(7):723–34. https://doi.org/10.1007/s11739-014-1124-1.

    Article  PubMed  Google Scholar 

  12. Onder G, van der Cammen TJM, Petrovic M, Somers A, Rajkumar C. Strategies to reduce the risk of iatrogenic illness in complex older adults. Age Ageing. 2013;42(3):284–91. https://doi.org/10.1093/ageing/aft038.

    Article  PubMed  Google Scholar 

  13. American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31. https://doi.org/10.1111/j.1532-5415.2012.03923.x.

    Article  Google Scholar 

  14. Balducci L. Aging, frailty, and chemotherapy. Cancer Control. 2007;14(1):7–12. http://www.ncbi.nlm.nih.gov/pubmed/17242666.

  15. Castelli R, Bergamaschini L, Schiavon R, Lambertenghi-Deliliers G. Personalized treatment strategies for elderly patients with myelodysplastic syndromes. Expert Rev Hematol. 2017. https://doi.org/10.1080/17474086.2017.1397509.

    PubMed  Google Scholar 

  16. Jädersten M, Malcovati L, Dybedal I, et al. Erythropoietin and granulocyte-colony stimulating factor treatment associated with improved survival in myelodysplastic syndrome. J Clin Oncol. 2008;26(21):3607–13. https://doi.org/10.1200/JCO.2007.15.4906.

    Article  PubMed  Google Scholar 

  17. Sperr WR, Wimazal F, Kundi M, et al. Comorbidity as prognostic variable in MDS: comparative evaluation of the HCT-CI and CCI in a core dataset of 419 patients of the Austrian MDS Study Group. Ann Oncol. 2010;21(1):114–9. https://doi.org/10.1093/annonc/mdp258.

    Article  CAS  PubMed  Google Scholar 

  18. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83. http://www.ncbi.nlm.nih.gov/pubmed/3558716. Accessed 14 Feb 2017.

  19. Miller MD, Paradis CF, Houck PR, et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res. 1992;41(3):237–48.

    Article  CAS  PubMed  Google Scholar 

  20. Della Porta MG, Malcovati L, Strupp C, et al. Risk stratification based on both disease status and extra-hematologic comorbidities in patients with myelodysplastic syndrome. Haematologica. 2011;96(3):441–9. https://doi.org/10.3324/haematol.2010.033506.

    Article  PubMed  Google Scholar 

  21. Malcovati L, Della Porta MG, Strupp C, et al. Impact of the degree of anemia on the outcome of patients with myelodysplastic syndrome and its integration into the WHO classification-based Prognostic Scoring System (WPSS). Haematologica. 2011;96(10):1433–40. https://doi.org/10.3324/haematol.2011.044602.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Della Porta MG. Prognostic models in myelodysplastic syndromes. Lancet Haematol. 2015;2(6):e229–30. https://doi.org/10.1016/S2352-3026(15)00110-6.

    Article  PubMed  Google Scholar 

  23. Jädersten M, Malcovati L, Dybedal I, et al. Erythropoietin and granulocyte-colony stimulating factor treatment associated with improved survival in myelodysplastic syndrome. J Clin Oncol. 2008;26(21):3607–13. https://doi.org/10.1200/JCO.2007.15.4906.

    Article  PubMed  Google Scholar 

  24. Santini V, Alessandrino PE, Angelucci E, et al. Clinical management of myelodysplastic syndromes: update of SIE, SIES. GITMO practice guidelines. Leuk Res. 2010;34(12):1576–88. https://doi.org/10.1016/j.leukres.2010.01.018.

    Article  CAS  PubMed  Google Scholar 

  25. Villegas A, Arrizabalaga B, Fernández-Lago C, et al. Darbepoetin alfa for anemia in patients with low or intermediate-1 risk myelodysplastic syndromes and positive predictive factors of response. Curr Med Res Opin. 2011;27(5):951–60. https://doi.org/10.1185/03007995.2011.561834.

    Article  CAS  PubMed  Google Scholar 

  26. Almeida A, Fenaux P, List AF, Raza A, Platzbecker U, Santini V. Recent advances in the treatment of lower-risk non-del(5q) myelodysplastic syndromes (MDS). Leuk Res. 2017;52:50–7. https://doi.org/10.1016/j.leukres.2016.11.008.

    Article  CAS  PubMed  Google Scholar 

  27. Fenaux P, Gattermann N, Seymour JF, et al. Prolonged survival with improved tolerability in higher-risk myelodysplastic syndromes: azacitidine compared with low dose ara-C. Br J Haematol. 2010;149(2):244–9. https://doi.org/10.1111/j.1365-2141.2010.08082.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Fenaux P, Mufti GJ, Hellström-Lindberg E, et al. Azacitidine prolongs overall survival compared with conventional care regimens in elderly patients with low bone marrow blast count acute myeloid leukemia. J Clin Oncol. 2010;28(4):562–9. https://doi.org/10.1200/JCO.2009.23.8329.

    Article  CAS  PubMed  Google Scholar 

  29. Seymour JF, Fenaux P, Silverman LR, et al. Effects of azacitidine compared with conventional care regimens in elderly (≥ 75 years) patients with higher-risk myelodysplastic syndromes. Crit Rev Oncol Hematol. 2010;76(3):218–27. https://doi.org/10.1016/j.critrevonc.2010.04.005.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Zeidan AM, Sekeres MA, Garcia-Manero G, et al. Comparison of risk stratification tools in predicting outcomes of patients with higher-risk myelodysplastic syndromes treated with azanucleosides. Leukemia. 2016;30(3):649–57. https://doi.org/10.1038/leu.2015.283.

    Article  CAS  PubMed  Google Scholar 

  31. Garcia-Manero G, Gore SD, Kambhampati S, et al. Efficacy and safety of extended dosing schedules of CC-486 (oral azacitidine) in patients with lower-risk myelodysplastic syndromes. Leukemia. 2016;30(4):889–96. https://doi.org/10.1038/leu.2015.265.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital Milan, Milan, Italy

    Roberto Castelli, Riccardo Schiavon & Giorgio Lambertenghi Deliliers

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  1. Roberto Castelli
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  2. Riccardo Schiavon
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  3. Giorgio Lambertenghi Deliliers
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Correspondence to Roberto Castelli.

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Castelli, R., Schiavon, R. & Deliliers, G.L. The impact of anaemia, transfusion dependency, comorbidities and polypharmacy in elderly patients with low-risk myelodysplastic syndromes. Med Oncol 35, 33 (2018). https://doi.org/10.1007/s12032-018-1094-7

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