REINHARD STAUDER (INNSBRUCK)
ROLE OF COMORBIDITIES AND QUALITY OF LIFE IN PROGNOSIS.
NEW EVALUATION SCALES (QUALMS…)
Reinhard STAUDER MD, MSc, Associate Professor
Department of Internal Medicine V (Haematology and Oncology)
Innsbruck Medical University
Anichstraße 35, 6020 Innsbruck, Austria
reinhard.stauder@i-med.ac.at
Background: Considering the increasing number of treatment options and the heterogeneity of
patients with MDS, decision making and selection of the appropriate treatment is rather complex in
patients with MDS and relies on valid prognostic and predictive parameters. So far, the IPSS-R
represents the gold-standard in prognostication in MDS. However, parameters of the IPSS-R reflect
exclusively the biology of the disease. Thus, the relevance of patient-centered factors namely of
comorbidities and patient-reported outcomes (PROs) in the evaluation of patients has been
recognised and suggested in the last years.
Relevance of comorbidities: The integration of comorbidities in decision making is essential, as
comorbidities are usually highly prevalent and increase with advanced age. Moreover, comorbidities
affect therapy planning and completion, are associated with therapy complications and adverse clinical
course. Importantly, the presence of distinct molecular aberrations and inflammatory processes has
been associated with severity of comorbidities and non-haematological morbidity and mortality. Thus,
the analysis of associations between biological characteristics and comorbidities is a hot topic in
hematologic research.
Whereas analyses of comorbidities are essential, many of these studies are hampered by the fact that
prospective evaluations of comorbidities based on validated scores are so far rare. As these conditions
reveal a great variability in severity and frequency, they should be quantified by established scores.
Scores often used in haematological malignancies are the Charlson Comorbidity Index (CCI), the
Cumulative Illness Rating Scale–Geriatric (CIRS G), the MDS-specific comorbidity index (MDS-CI) and
the Short Form 36 (SF-36), respectively. Moreover, the HCT-Comorbidity Index (HCT-CI) has been
developed mainly to assess the feasibility for a hematopoietic stem cell transplantation (HSCT).
This presentation will give an overview on the prevalence of comorbidities in patients with MDS, on
the different scores described in the literature to assess comorbidities, their use in MDS in daily
practice, and the results obtained so far with focus on prognostication.
Health-related quality of life in MDS: MDS patients experience a significant symptom burden and
restrictions in their health-related quality of life (HRQOL), which can negatively influence clinical
outcomes. Patient-reported outcome (PRO) is a collective name for any information about a patient’s
health condition that comes directly from the patient without any interference or interpretation from
clinical experts. Patient-reported outcome measures (PROMs) are designed to measure the patient
experience that cannot be obtained from an observer, but from the patient only, for example fatigue,
symptom severity, impact on daily activities, and HRQOL.
Health related quality of life (HRQOL) represents a typical PRO. HRQOL is multi-dimensional and
reflects the physical, mental, emotional and social wellbeing of an individual. Thus, assessment goes
beyond the health status assessed in clinical routine. Assessments of HRQOL try to capture these
dimensions in order to allow for a patient-centred treatment approach. A huge variety of scores is