Early introduction of ESA in low risk MDS patients may delay the need for RBC transfusion: A retrospective analysis on 112 patients
Hôpital Cochin, APHP, Paris, France. Leukemia research
(Impact Factor: 2.35).
11/2010; 34(11):1430-6. DOI: 10.1016/j.leukres.2010.05.030
ESAs are increasingly used to treat anemia of lower risk MDS, even before RBC transfusion requirement. From a previously published patient cohort treated with ESAs, we selected 112 patients with de novo low or int-1 IPSS MDS with Hb<10 g/dl, serum EPO<500 UI/l and who had never been transfused. Erythroid response rate at 12 weeks was 63.1% (IWG 2006). In multivariate analysis, an interval between diagnosis and ESA onset<6 months, Hb level>9 g/dl, and serum EPO<100 UI/l predicted better response to ESA while shorter interval between diagnosis and ESA onset (p=0.01), lower serum EPO (p=0.04) and WHO diagnosis of RCMD-RS (p=0.03) were associated with longer response. Median interval from diagnosis to transfusion dependency was 80 months and 35 months, respectively, in patients with onset of ESA < 6 months and ≥ 6 months from diagnosis (p=0.007). Those results support early onset of ESA in lower risk MDS, to better avoid the consequences of anemia. Early introduction of ESA may also delay the need for RBC transfusions, hypothetically by slowing the disease course, but prospective studies are required to further assess this point.
Available from: Mark Drummond
- "Paediatric dosing of 105 lg 2/3 times per week is a popular and cost effective way of starting the treatment. One study has suggested that starting ESA therapy within 6 months of diagnosis improved response rates and delayed the onset of transfusions, 80 months vs. 35 months, compared to later initiation of ESA (Park et al, 2010). "
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ABSTRACT: of key recommendations Diagnosis 1 Myelodysplastic syndrome (MDS) should be suspected in patients with otherwise unexplained cytopenias(s) or mac-rocytosis. Grade 1A 2 The initial assessment of a patient with unexplained cytopenias(s) may not confirm a diagnosis of MDS. Fur-ther follow-up and reassessment may be necessary to reach a firm diagnosis. Grade 2B,C 3 Initial assessment of a patient with suspected MDS should include a minimum set of investigations and the differen-tial diagnosis of marrow dysplasia should be considered. Grade 1A 4 Patients with MDS should be assessed by a haematologist and, except where clearly inappropriate, offered review by a regional or national expert given the disease rarity. 5 All cases of MDS should be classified according to the World Health Organization (WHO) Revised Classification 2008. Grade 1A 6 Bone marrow cytogenetic analysis should be performed on all patients with suspected MDS having a bone marrow examination. Grade 1A 7 Consideration should be given at diagnosis to the progno-sis for each individual patient, with application of the revised International Prognostic Scoring System (IPSS-R). Grade1B 8 All cases of MDS should be reported to the National Cancer Registry and MDS-specific registries if applicable.
Available from: Mario Petrini
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ABSTRACT: We investigated the efficacy of alpha recombinant human erythropoietin (α-rHuEPO) administered as single agent to 133 patients affected by myelodysplastic syndromes referring to our Institution in the last 10 years. WPSS score was "very low" in 67%, "low" in 19%, "intermediate" in 14%. The starting schedule was: 40,000 IU bi-weekly, with reduction or suspension, when necessary, in responsive patients. According to new IWG criteria, response rate (RR) was 75%, 66%, 59% after 8, 16, 24 weeks, respectively. Comparing "very low" and "low/intermediate" risk, RR was 81% vs. 43% (P < 0.001); 70% vs. 45% (P = 0.040); 63% vs. 42% (P = NS) after 8, 16, 24 weeks. RR was significantly influenced by transfusion dependence (P = 0.039) and basal serum EPO level (P < 0.001). Mean Hb value was 94 ± 11 g/l before therapy; 114 ± 19 after 8 weeks (P < 0.001); 116 ± 18 after 16 weeks (P < 0.001); 114 ± 17 after 24 weeks (P < 0.001). Reduction or suspension of therapy significantly affected Hb level after 4 (P < 0.001) and 8 weeks (P < 0.01). Conversely, restart of full dosage significantly enhanced again Hb level after 4 (P < 0.01) and 8 weeks (P < 0.001). 65% patients are alive (mean survival: 74 weeks). Seventy percent are alive in the "very low risk" group and 38% in "low/intermediate risk" group (P < 0.001). Overall mean follow-up was 69 weeks (range, 8-376): it was 80 weeks in responsive patients (max 376) and 38 weeks in patients who progressively became unresponsive (max 168) (P < 0.01). Median response was 36 weeks, with 33% of patients still responding after one year. Treatment was well tolerated.
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