Impact of comorbidities by ACE-27 in the revised-IPSS for patients with myelodysplastic syndromes

Comorbidities significantly affect the prognosis and outcomes of patients with hematological malignancies. We have previously reported the impact of comorbidities on the International Prognostic Scoring System (IPSS) score. The aim of this study was to determine whether comorbidities continued to have a significant impact when patients were reclassified according to the Revised-IPSS (IPSS-R). The medical records of 600 consecutive myelodysplastic syndrome patients who presented to MD Anderson Cancer Center between January 2002 and June 2004 were reviewed. The Adult Comorbidity Evaluation-27 (ACE-27) was used to assess the severity of comorbid conditions. Four hundred and two (67%) patients were male. Median age at presentation was 66.6 years (17-94). Mean duration of follow-up was 54 months (1-100). Five hundred and two (84%) patients died, and 54 (9%) patients underwent stem cell transplantation. Overall median survival was 16.8 months (1-100). Median survival by IPSS-R was 47, 34, 21, 16, and 6 months for patients in very low, low, intermediate, high, and very high-risk groups, respectively (P<0.001). The ACE-27 comorbidity score significantly impacted the median survival of patients in the intermediate (P<0.001), high (P=0.045), and very high (P=0.004) IPSS-R groups; but did not significantly impact the median survival in the low (P=0.11) and very low (P=0.49) IPSS-R groups. The ACE-27 comorbidity score significantly impacted the median survival of patients ≤65 years (P<0.001) but did not significantly impact those >65 years (P=0.18). Assessment of comorbidity may enhance the prognostic ability of the IPSS-R.