The critical role of comorbidities and polypharmacy in lower risk myelodysplastic patients: is there any difference between countries?
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To the editor,
We read with interest the paper recently published by Castelli et al. , who assessed the important relationship between anemia, transfusion dependency, comorbidities, and polypharmacy in 155 low-risk myelodysplastic syndrome (MDS) patients from two centers in Milan, Italy. Therefore, we felt very motivated to discuss and complement their findings in a comparative study in Brazilian patients.
MDS is a prevalent clonal hematopoietic stem cell disorder that affects predominantly older individuals, who are prone to developing comorbidities. Both, multiple comorbidities and age, have been shown to be important negative prognostic factors in low-risk MDS patients. Recently, Brunner et al.  showed that MDS patients were more likely to die of cardiovascular diseases than population in general, in a large American cohort. Evaluating and controlling extra-hematological comorbidities is important to enable aggressive therapeutic strategies (i.e., hypomethylating agents,...
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Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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