Geriatric Assessment Variables Add Prognostic Value to the International Prognostic Scoring System

Existing risk assessment systems for MDS such as the International Prognostic Scoring System (IPSS) do not include information on geriatric assessment domains.

Objective: To determine whether baseline geriatric assessment variables add important prognostic information to the IPSS in a cohort of older patients with MDS.

Methods: We aimed to prospectively enroll all consecutive patients with MDS ≥ 65 years of age who presented to Dana-Farber Cancer Institute between 2006 and 2011. All patients completed the EORTC QLQ C-30 quality of life questionnaire at their initial visit. We evaluated questions corresponding to geriatric domains including physical, social and cognitive functions, psychological state, nutrition and pain. We extracted patient demographics and clinico-pathologic data from medical records. Baseline comorbidity score was calculated using the Charlson Comorbidity Index. We used Kaplan-Meier and Cox proportional hazards models to estimate survival. Variables associated with mortality on univariate tests of significance were included in the multivariate model. We used a stepwise selection process to find the model that best predicted mortality.

Results: 114 patients with MDS ≥ 65 consented to be followed and were available for analysis. The median age at diagnosis was 72. 5 years. The majority of patients were white (94. 8%), male (62. 4%) and had at least one household member (88. 2%) with whom they resided. 30% of patients had a body mass index > 30 kg/m² and 91% had and albumin level > 3. 5 g/dL. Nearly 40% of patients had a Charlson score of 0, 16. 7% had a score of 1, 26. 3% had a score of 2 and 19. 3% had a score of 3 or greater. Only 23. 9% had an IPSS score consistent with low risk disease, while 71. 7% had intermediate and 4. 4% had high risk scores. 56 patients (49%) were initially treated with low dose chemotherapy (azacitidine or decitabine), 7% with induction chemotherapy, and 32% with experimental or other therapies. 11% of patients underwent a BMT, and 25% of these maintained complete remission (3 patients).

The median survival of the cohort was 25 months. The strongest univariate predictor of overall survival was low serum albumin followed by history of chemotherapy or radiation, IPSS score, Charlson score, and questions on the ability to tolerate a long walk and whether physical symptoms or treatment had interfered with family life (Table 1). Age was not a significant predictor of mortality in this cohort. The multivariate model that best predicted survival included serum albumin, history of previous chemotherapy or radiation, IPSS score, and ability to take a long walk (Table 2).

Conclusions: In this study of highly selected older adults with MDS, we found that markers of nutritional status and self-reported physical function added important prognostic information to the IPSS score. Our findings suggest the utility of developing comprehensive risk assessment tools for older patients with MDS that include geriatric as well as genetic and disease-specific domains.

No relevant conflicts of interest to declare.