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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 CML patients aged 60–89 years
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Fig3: Stacked cumulative probability of cancer-specific and other-cause death, among CML patients aged 60–89 years

Mentions: In analyses of specific comorbid diseases, most tended to be associated with a nominally higher all-cause as well as CML-specific mortality, but numbers were low reducing the precision. History of cardiovascular and renal disorders and dementia were significantly associated with all-cause death, whereas only renal disorders were associated with increased risk of CML-specific death (MRR = 7.47, 95 % CI: 1.66–33.6) (Fig. 1). Among men 70–89 years of age (but not those aged 60–69 years), the probability of dying from causes other than CML was greater than the probability of dying from CML within 5 years after diagnosis, regardless of the presence or absence of comorbidity (Fig. 3). Among men 60–69 years, the 5-year probability of CML-specific death was significantly higher for those with comorbid disease than those without (31 vs 18 %, difference 12.6 %, 95 % CI: 2.5–22.7, Additional file 3: Table S3). In older age groups there were no statistically significant differences in probabilities of cancer-specific or other-cause death among patients with and without comorbidities. In contrast, among women, comorbid disease conferred a higher probability of mainly cancer-specific death in ages 80–89 years (55 vs 41 %, difference 13.7, 95 % CI: 3.6–23.8) but no significant differences in cancer-specific or other-cause death in younger age groups (Additional file 4: Table S4).Fig. 3


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 CML 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

Fig3: Stacked cumulative probability of cancer-specific and other-cause death, among CML patients aged 60–89 years
Mentions: In analyses of specific comorbid diseases, most tended to be associated with a nominally higher all-cause as well as CML-specific mortality, but numbers were low reducing the precision. History of cardiovascular and renal disorders and dementia were significantly associated with all-cause death, whereas only renal disorders were associated with increased risk of CML-specific death (MRR = 7.47, 95 % CI: 1.66–33.6) (Fig. 1). Among men 70–89 years of age (but not those aged 60–69 years), the probability of dying from causes other than CML was greater than the probability of dying from CML within 5 years after diagnosis, regardless of the presence or absence of comorbidity (Fig. 3). Among men 60–69 years, the 5-year probability of CML-specific death was significantly higher for those with comorbid disease than those without (31 vs 18 %, difference 12.6 %, 95 % CI: 2.5–22.7, Additional file 3: Table S3). In older age groups there were no statistically significant differences in probabilities of cancer-specific or other-cause death among patients with and without comorbidities. In contrast, among women, comorbid disease conferred a higher probability of mainly cancer-specific death in ages 80–89 years (55 vs 41 %, difference 13.7, 95 % CI: 3.6–23.8) but no significant differences in cancer-specific or other-cause death in younger age groups (Additional file 4: Table S4).Fig. 3

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