Frailty is increasingly recognized as important to outcomes in Myelodysplastic Syndrome (MDS). Physical performance measures such as grip strength are common markers associated with frailty and predict mortality in other cancer populations. The value of these markers in MDS accounting for patient and disease specific factors is not well described. The MDS-CAN registry (NCT02537990) of patients with MDS, MDS/MPN, or low-blast AML (20-30%) was used to evaluate the association between physical performance measures and survival. Specific physical performance assessments included grip strength, 4-meter walk test, and 10× sit-stand test. Among 1,372 patients in our cohort (mean age 73.5 years), median follow-up was 2.8 years and 60.6% died. Median OS increased across grip strength quartiles, from 23.6 months in the lowest quartile to 45.0 months in the highest, while five-year OS was 39.3% in patients with grip strength above the median versus 27.5% below. Faster 4-meter walk, and shorter sit-stand times were also associated with improved OS but in multivariable analysis, only grip strength retained significance. Grip strength below the median remained independently associated with worse OS, alongside Rockwood Clinical Frailty Scale, IPSS-R, age over 70, ferritin, fatigue, and comorbidity burden. Grip strength is a simple tool associated with survival in MDS, providing prognostic information beyond established frailty and disease-based risk scores. The incorporation of physical performance measures may enhance risk stratification and inform future studies on treatment outcomes.
