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Prevalence and association of frailty with clinical outcomes in myeloproliferative neoplasms: a population-based study


Clinical implications of frailty in myeloproliferative neoplasms (MPN)- essential thrombocythemia (ET), polycythemia vera (PV), myelofibrosis (MF) is unknown. In this population-based study, all incident cases of MPN from Ontario cancer registry between 2004-2019 (N=10,336, ET=5,108; PV=3,843; MF=1,385) and their matched controls (for age, sex, residence, income) in 1:4 ratio were included. Baseline frailty measured using Johns Hopkins Adjusted Clinical Groups frailty indicator and McIsaac’s frailty index (mFI), categorized as fit, prefrail, or frail if mFI <0.10, 0.11-0.20, > 0.20) was significantly higher in ET, PV and MF compared to matched controls [standardized mean difference 0.27, 0.27 and 0.28]. Over 23%, 20% and 34% patients with ET, PV and MF were frail or prefrail despite younger age (<65 years) or minimal comorbidities. In Cox-proportional regression, frailty was independently associated with worse overall survival (OS) after adjusting for age, sex, comorbidities compared to mFI-fit patients: hazard ratio (95% CI) for OS for mFI-prefrail and mFI-frail patients were: 1.6 (1.3-1.9), and 3.6 (2.9-4.4) in ET; 1.3 (1.1-1.5) and 2.7 (2.1-3.4) in PV, and 1.2 (1.0-1.5) and 2.0 (1.5-2.7) in MF. MPN patients have substantially higher prevalence of frailty compared to matched controls which is associated with reduced OS, independent of age or comorbidities.



Bankar A, Chan WC, Liu N, Cheung MC, Alibhai SM, Gupta V. Blood Adv. 2023; May 15 [Epub ahead of print].

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