Comorbidity Index Predicts Vulnerability of Patients With Myelofibrosis

For patients diagnosed with myelofibrosis (MF), factors such as age and presence of existing cardiac disease or symptoms can help predict the course of the disease. Investigators in a recent study sought to determine if use of an existing index for myelodysplastic syndrome (MDS), which has many overlapping features with MF, would be useful as a prognostic tool in MF.

The Myelodysplastic Syndrome (MDS)-Specific Comorbidity Index (MDS-CI) examines comorbidities in 4 major organ systems—heart, lung, liver, and kidney—and combines results with the presence of solid tumors to assess survival in patients with MDS. Investigators evaluated the prognostic potential of MDS-CI compared with current evaluation tools, including the Dynamic International Prognostic Scoring System (DIPSS) and a tool that includes mutational status.

Investigators from Cantonal Hospital, St Gallen, Switzerland, evaluated 70 patients diagnosed from 2000 to 2020 with MF through a retrospective chart review. None of the patients had received allogeneic stem cell transplantation. Median follow-up was 40 months. The most common comorbidities were cardiac diseases (23 patients) and solid tumors (12 patients).

Overall survival was significantly influenced by the MDS-CI. The median OS for patients with a low MDS-CI was 101 months (25 patients). For those with an intermediate MDS-CI, median survival was 50 months; and for those with a high MDS-CI (7 patients), median survival was 8 months (P < .001).

“Our small and retrospective study demonstrates that the applicability of the MDS-CI can surpass prognostication in MDS because it can be used for the prognostication of patients with MF as well,” the investigators wrote, stating that this index classified MF patients “as being more vulnerable due to their comorbidities, even after stratification by other indices.

The authors found that using a prognostic tool separate the DIPSS, which the MDS-CI allows, served the highlight the importance of comorbidities even if a patient’s mutational profile has been considered.

The MDS-CI is easy to calculate, the authors noted; it only requires basic laboratory values that should be available following a thorough physical examination and carefully taken history; tests would include electrocardiography, echocardiography, and pulmonary function.

Of note, the authors wrote, “atrial fibrillation (AF) is highly weighted in the MDS-CI” and this is important given the well-established association of AF with cardiovascular risk factors. The index also evaluates renal insufficiency and liver function, which have implications in MF.

The focus on core comorbidities in the MDS-CI “may represent an advantage,” the authors wrote, as it does not result in overassessment that might be of “questionable relevance.” But the one component the authors suggested might be lacking it used in MF is that it does not consider venous thromboembolism and peripheral and cerebrovascular disease.

“The analysis of our small and retrospective MF cohort suggests that the

MDS-CI represents a useful tool to identify MF patients with an increased vulnerability due to comorbidities,” the investigators wrote. “However, analyses of larger cohorts are necessary to define the value of the MDS-CI as a prognostic tool in comparison with other comorbidity indices.”

Reference

Koster KL, Messerich NM, Volken T.Prognostic significance of the myelodysplastic syndrome-specific comorbidity index (MDS-CI) in patients with myelofibrosis: a retrospective study. Cancers. 2023;15(4698). https://doi.org/10.3390/cancers15194698.