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

BMC Cancer

Research Article

Sandra Eloranta¹  Ingrid Glimelius²  Karin E. Smedby³  Mohammad Mohammadi⁴  Yang Cao⁵  Matteo Bottai⁵ 

[1] Department of Medicine, Clinical Epidemiology Unit, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden;Department of Medicine, Clinical Epidemiology Unit, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden;Department of Immunology, Genetics and Pathology, Unit of Oncology, Uppsala University, Uppsala, Sweden;Department of Medicine, Clinical Epidemiology Unit, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden;Hematology Center, Karolinska University Hospital, Stockholm, Sweden;Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden;Institute of Environmental Medicine, Unit of Biostatistics, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden;

关键词: Acute Myeloid Leukemia;    Myeloma;    Chronic Myeloid Leukemia;    Hematological Malignancy;    Acute Myeloid Leukemia Patient;   

DOI  :  10.1186/s12885-015-1857-x

 received in 2015-06-10, accepted in 2015-10-27,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundComorbidity 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.MethodsUsing 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.ResultsComorbidity 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.ConclusionComorbidities 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.

【 授权许可】

CC BY   
© Mohammadi et al. 2015