Impact of Individual Comorbidities on Survival of Patients with Myelofibrosis

García-Fortes M; Hernández-Boluda JC; Álvarez-Larrán A; Raya JM; Angona A; Estrada N; Fox L; Cuevas B; García-Hernández MC; Gómez-Casares MT; Ferrer-Marín F; Saavedra S; Cervantes F; García-Delgado R; On Behalf Of The Grupo Español de Enfermedades Mieloproliferativas Filadelfia Negativas Gemfin.


Simple Summary The coexistence of cancer with other chronic conditions has substantial implications for treatment decisions and outcomes for both neoplasms and chronic disease. Reports have demonstrated the impact of comorbidities on survival in different hematologic disorders. Myelofibrosis (MF) guidelines do not consider the complex interrelations between MF and comorbidity. Several works have shown how MF patients have a wide variety and high burden of comorbidities and demonstrated that the comorbidity burden was significantly associated with an unfavorable impact on survival. These previous studies about comorbidity on MF are retrospective and consider the cumulative rather than individual comorbidity burden. The influence of individual comorbidities on outcome in MF patients has not been studied. We sought to identify the comorbidities in MF patients at diagnosis and to assess the influence of those different comorbidities on survival. Considering them individually may contribute to the personalization of MF management and optimizing outcomes. The comorbidity burden is an important risk factor for overall survival (OS) in several hematological malignancies. This observational prospective study was conducted to evaluate the impact of individual comorbidities on survival in a multicenter series of 668 patients with primary myelofibrosis (PMF) or MF secondary to polycythemia vera (PPV-MF) or essential thrombocythemia (PET-MF). Hypertension (hazard ratio (HR) = 4.96, p < 0.001), smoking (HR = 5.08, p < 0.001), dyslipidemia (HR = 4.65, p < 0.001) and hepatitis C virus (HCV) (HR = 4.26, p = 0.015) were most adversely associated with OS. Diabetes (HR = 3.01, p < 0.001), pulmonary disease (HR = 3.13, p < 0.001) and renal dysfunction (HR = 1.82, p = 0.037) were also associated with an increased risk of death. Multivariate analysis showed that pulmonary disease (HR = 2.69, p = 0.001), smoking (HR = 3.34, p < 0.001), renal dysfunction (HR = 2.08, p = 0.043) and HCV (HR = 11.49, p = 0.001) had a negative impact on OS. When ruxolitinib exposure was included in the model, the effect of each comorbidity on survival was modified. Therefore, individual comorbidities should be taken into account in determining the survival prognosis for patients with MF.

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