A comparison of the effect of three different comorbidity indices on overall survival in patients with chronic myeloid leukemia

Abstract

Aims: It was aimed at measuring the comorbidities of chronic myeloid leukemia (CML) patients at the time of diagnosis with different comorbidity indices and evaluating their effects on disease prognosis.Methods: The comorbidities of the patients were retrospectively screened and calculated in three different comorbidity indices: the ACE-27 Comorbidity Index, the Age-adjusted Charlson Comorbidity Index, and the Elixhauser Comorbidity Index. C-statistic was used to evaluate the ability of comorbidity indices to discriminate mortality. The relationship between the calculated scores and overall survival (OS) was evaluated with the Kaplan-Meier curve. Mortality risk was analyzed with a multivariate Cox regression model.Results: A total of 218 CML patients were evaluated, and 211 chronic-phase patients were included in this study. The median age of the patients was 56 years (21-89), and 53% were female. As initial tyrosine kinase inhibitors, 201 (95%) patients were treated with imatinib, 10 (5%) patients with nilotinib. The median follow-up was 94.50 (9-201) months. The median OS was not reached. The most common comorbid conditions were hypertension 23% (n = 48), weight loss 19% (n = 40), diabetes mellitus 13% (n = 27), and cardiovascular disease 9% (n = 19). C-statistic values were 0.76 for ACE-27, 0.41 for ACCI, and 0.32 for ECI scores. In the Cox regression model including comorbidity scores, mortality risk was higher in patients with moderate ACE-27 score (HR: 148.05; 95% CI: 7.89-2751.53; p = 0.012), severe ACE-27 score (HR: 232.36; 95% CI: 14.20-4793.20; p = 0.001), ECOG 3 score (HR: 34.62; 95% CI: 2.67-447.36; p = 0.007), and high ELTS score (HR: 27.52; 95% CI: 1.34-543.68; p = 0.031).Conclusion: This study showed that the ACE-27 Comorbidity Index is effective in predicting prognosis in CML patients. Therefore, comorbid conditions should be used more frequently as a prognostic marker at the time of diagnosis.