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The impact of comorbid disease history on all-cause and cancer-specific mortality in myeloid leukemia and myeloma - a Swedish population-based study.

Mohammadi M, Cao Y, Glimelius I, Bottai M, Eloranta S, Smedby KE - BMC Cancer (2015)

Bottom Line: Comorbidity was associated with increased all-cause as well as cancer-specific mortality (cancer-specific MRR: AML = 1.27, 95 % CI: 1.15-1.40; CML = 1.28, 0.96-1.70; myeloma = 1.17, 1.08-1.28) compared with patients without comorbidity.The difference in the probability of cancer-specific death, comparing patients with and without comorbidity, was largest among AML patients <70 years, whereas in myeloma the difference did not vary by age among the elderly.The results highlight the need for a better balance between treatment toxicity and efficacy in comorbid and elderly AML, CML and myeloma patients.

View Article: PubMed Central - PubMed

Affiliation: Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. mohammad.mohammadi@ki.se.

ABSTRACT

Background: Comorbidity increases overall mortality in patients diagnosed with hematological malignancies. The impact of comorbidity on cancer-specific mortality, taking competing risks into account, has not been evaluated.

Methods: Using the Swedish Cancer Register, we identified patients aged >18 years with a first diagnosis of acute myeloid leukemia (AML, N = 2,550), chronic myeloid leukemia (CML, N = 1,000) or myeloma (N = 4,584) 2002-2009. Comorbid disease history was assessed through in- and out-patient care as defined in the Charlson comorbidity index. Mortality rate ratios (MRR) were estimated through 2012 using Poisson regression. Probabilities of cancer-specific death were computed using flexible parametric survival models.

Results: Comorbidity was associated with increased all-cause as well as cancer-specific mortality (cancer-specific MRR: AML = 1.27, 95 % CI: 1.15-1.40; CML = 1.28, 0.96-1.70; myeloma = 1.17, 1.08-1.28) compared with patients without comorbidity. Disorders associated with higher cancer-specific mortality were renal disease (in patients with AML, CML and myeloma), cerebrovascular conditions, dementia, psychiatric disease (AML, myeloma), liver and rheumatic disease (AML), cardiovascular and pulmonary disease (myeloma). The difference in the probability of cancer-specific death, comparing patients with and without comorbidity, was largest among AML patients <70 years, whereas in myeloma the difference did not vary by age among the elderly. The probability of cancer-specific death was generally higher than other-cause death even in older age groups, irrespective of comorbidity.

Conclusion: Comorbidities associated with organ failure or cognitive function are associated with poorer prognosis in several hematological malignancies, likely due to lower treatment tolerability. The results highlight the need for a better balance between treatment toxicity and efficacy in comorbid and elderly AML, CML and myeloma patients.

No MeSH data available.


Related in: MedlinePlus

Stacked cumulative probability of cancer-specific and other-cause death among AML patients aged 60–89 years
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Fig2: Stacked cumulative probability of cancer-specific and other-cause death among AML patients aged 60–89 years

Mentions: In analyses of the absolute impact of comorbid disease history in the age groups 60–69, 70–79 and 80–89 years by sex, the probability of dying from AML was greater than the probability of dying from other causes in both sexes and in all investigated age groups, irrespective of the presence of comorbid disease (Fig. 2, Additional file 3: Table S3). The proportion of male patients aged 60–79 years who died from AML within the first 5 years after diagnosis was significantly higher for patients with at least one comorbid disease than for those without (ages 60–69: 76 % vs 65 %, difference 11 % (95 % CI 3.5–19); ages 70–79: 86 % vs 81 %, difference 4.8 % (95 % CI 1.5–7.9)) . Among patients 80–89 years, comorbid disease history was not associated with a higher cancer-specific probability of death (Fig. 2). For female patients aged 60–89 years, the pattern was similar, although in the oldest group, AML-specific deaths encompassed a larger share of all deaths as compared to males (Fig. 2, Additional file 4: Table S4).Fig. 2


The impact of comorbid disease history on all-cause and cancer-specific mortality in myeloid leukemia and myeloma - a Swedish population-based study.

Mohammadi M, Cao Y, Glimelius I, Bottai M, Eloranta S, Smedby KE - BMC Cancer (2015)

Stacked cumulative probability of cancer-specific and other-cause death among AML patients aged 60–89 years
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4634819&req=5

Fig2: Stacked cumulative probability of cancer-specific and other-cause death among AML patients aged 60–89 years
Mentions: In analyses of the absolute impact of comorbid disease history in the age groups 60–69, 70–79 and 80–89 years by sex, the probability of dying from AML was greater than the probability of dying from other causes in both sexes and in all investigated age groups, irrespective of the presence of comorbid disease (Fig. 2, Additional file 3: Table S3). The proportion of male patients aged 60–79 years who died from AML within the first 5 years after diagnosis was significantly higher for patients with at least one comorbid disease than for those without (ages 60–69: 76 % vs 65 %, difference 11 % (95 % CI 3.5–19); ages 70–79: 86 % vs 81 %, difference 4.8 % (95 % CI 1.5–7.9)) . Among patients 80–89 years, comorbid disease history was not associated with a higher cancer-specific probability of death (Fig. 2). For female patients aged 60–89 years, the pattern was similar, although in the oldest group, AML-specific deaths encompassed a larger share of all deaths as compared to males (Fig. 2, Additional file 4: Table S4).Fig. 2

Bottom Line: Comorbidity was associated with increased all-cause as well as cancer-specific mortality (cancer-specific MRR: AML = 1.27, 95 % CI: 1.15-1.40; CML = 1.28, 0.96-1.70; myeloma = 1.17, 1.08-1.28) compared with patients without comorbidity.The difference in the probability of cancer-specific death, comparing patients with and without comorbidity, was largest among AML patients <70 years, whereas in myeloma the difference did not vary by age among the elderly.The results highlight the need for a better balance between treatment toxicity and efficacy in comorbid and elderly AML, CML and myeloma patients.

View Article: PubMed Central - PubMed

Affiliation: Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. mohammad.mohammadi@ki.se.

ABSTRACT

Background: Comorbidity increases overall mortality in patients diagnosed with hematological malignancies. The impact of comorbidity on cancer-specific mortality, taking competing risks into account, has not been evaluated.

Methods: Using the Swedish Cancer Register, we identified patients aged >18 years with a first diagnosis of acute myeloid leukemia (AML, N = 2,550), chronic myeloid leukemia (CML, N = 1,000) or myeloma (N = 4,584) 2002-2009. Comorbid disease history was assessed through in- and out-patient care as defined in the Charlson comorbidity index. Mortality rate ratios (MRR) were estimated through 2012 using Poisson regression. Probabilities of cancer-specific death were computed using flexible parametric survival models.

Results: Comorbidity was associated with increased all-cause as well as cancer-specific mortality (cancer-specific MRR: AML = 1.27, 95 % CI: 1.15-1.40; CML = 1.28, 0.96-1.70; myeloma = 1.17, 1.08-1.28) compared with patients without comorbidity. Disorders associated with higher cancer-specific mortality were renal disease (in patients with AML, CML and myeloma), cerebrovascular conditions, dementia, psychiatric disease (AML, myeloma), liver and rheumatic disease (AML), cardiovascular and pulmonary disease (myeloma). The difference in the probability of cancer-specific death, comparing patients with and without comorbidity, was largest among AML patients <70 years, whereas in myeloma the difference did not vary by age among the elderly. The probability of cancer-specific death was generally higher than other-cause death even in older age groups, irrespective of comorbidity.

Conclusion: Comorbidities associated with organ failure or cognitive function are associated with poorer prognosis in several hematological malignancies, likely due to lower treatment tolerability. The results highlight the need for a better balance between treatment toxicity and efficacy in comorbid and elderly AML, CML and myeloma patients.

No MeSH data available.


Related in: MedlinePlus