The Geriatric Nutritional Risk Index predicts the Early Death and Survival in Patients with Myelodysplastic Syndrome and Acute Myeloid Leukemia with Myelodysplasia-related Changes treated with Azacitidine.

Making clinical decisions in myelodysplastic syndrome (MDS), a highly heterogeneous disease of clonal myeloid disorders, is essential for predicting the prognosis and risk of progression to acute myeloid leukemia (AML). Prognostic scoring systems have been established by several groups to assess disease risks; however, few of these systems consider patients' factors when predicting the prognosis. The geriatric nutritional risk index (GNRI) is a simple nutritional assessment tool calculated from the serum albumin level and the ratio between the actual and ideal body weight. The prognostic significance of GNRI has not been well studied in patients with MDS and AML with myelodysplasia-related changes (AML-MRC) treated with Azacitidine (AZA). To resolve this issue, we retrospectively analyzed a total of 86 MDS and AML-MRC patients treated with AZA at our institution between May 2011 and March 2019. The median follow-up time was 12 months. The optimal GNRI cut-off value for predicting the 2-year survival was determined by a receiver operating characteristic curve analysis to be 93.82. The incidence of early death within 3 months was significantly higher in patients with a low GNRI (<93.82) than those with a high GNRI (≥93.82) (34.5% vs 7%, P = 0.004). In a multivariate analysis, Performance Status (PS) ≥2 and a low GNRI (<93.82) were independent prognostic factors for early death within 3 months. Patients with a low GNRI (<93.82) had a significantly shorter overall survival (OS) than those with a high GNRI (≥93.82) (median OS, 9 months vs 13 months, P < 0.001). In a multivariate analysis, very high risk in Revised International Prognostic Scoring System (IPSS-R), PS ≥2, and low GNRI were independent prognostic factors for the OS. In this study, we showed that a low GNRI was strongly associated with a poor outcome in MDS and AML-MRC patients treated with AZA.