Self-reported fatigue assessment should be included in routine diagnostic investigation for patients with newly diagnosed higher-risk myelodysplastic syndromes and should be considered as a standard baseline stratification factor in future randomized controlled trials, according to an article published online ahead of print in JAMA Oncology.1

In this multicenter, observational, cohort study investigators sought to assess whether self-reported fatigue severity predicted overall survival better than gold-standard prognostic indices in patients with higher-risk myelodysplastic syndromes.

Adults with an intermediate-2-risk or high-risk International Prognostic Scoring System (IPSS) score were enrolled regardless of older age, comorbidities, and progression from a lower IPSS risk score category. All patients completed a quality of life assessment at baseline. A multivariate model of how prognostic variables predicted survival.

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A total of 280 patients were enrolled between November 10, 2008 and August 13, 2012. With a median follow-up of 15 months, the median overall survival from diagnosis was 17 months (95% CI: 15–19.

In multivariate analysis, baseline factors independently associated with reduced overall survival were high-risk IPSS score (hazard ratio [HR] 2.525; 95% CI: 1.357–4-697; P=0·0035) and a higher score for fatigue (1.110; 1.040–1.170, for every ten points of fatigue deterioration; P=0.0007).

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In further multivariate models for survival, including either the WHO-based prognostic scoring system or the revised version of the IPSS classification, self-reported fatigue was a statistically significant independent prognostic factor with a HR of 1.120 (1.050–1.180; P=0.0003) and a HR of 1.130 (1.060–1.190; P=0·0002), respectively. 


  1. Efficace F, Gaidano G, Breccia M, et al. Prognostic value of self-reported fatigue on overall survival in patients with myelodysplastic syndromes: a multicentre, prospective, observational, cohort study. [published online ahead of print September 21, 2015]. Lancet Oncol. doi: 10.1016/S1470-2045(15)00206-5.