Premium
Erythropoiesis‐stimulating agents significantly delay the onset of a regular transfusion need in nontransfused patients with lower‐risk myelodysplastic syndrome
Author(s) -
Garelius H. K. G.,
Johnston W. T.,
Smith A. G.,
Park S.,
de Swart L.,
Fenaux P.,
Symeonidis A.,
Sanz G.,
Čermák J.,
Stauder R.,
Malcovati L.,
Mittelman M.,
van de Loosdrecht A. A.,
van Marrewijk C. J.,
Bowen D.,
Crouch S.,
de Witte T. J. M.,
HellströmLindberg E.
Publication year - 2017
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/joim.12579
Subject(s) - medicine , international prognostic scoring system , observational study , anemia , myelodysplastic syndromes , proportional hazards model , lower risk , prospective cohort study , propensity score matching , blood transfusion , surgery , confidence interval , bone marrow
Background The EUMDS registry is an unique prospective, longitudinal observational registry enrolling newly diagnosed patients with lower‐risk myelodysplastic syndrome ( MDS ) from 17 European countries from both university hospitals and smaller regional hospitals. Objective The aim of this study was to describe the usage and clinical impact of erythropoiesis‐stimulating agents ( ESA s) in 1696 patients enrolled between 2008 and 2014. Methods The effects of ESA s on outcomes were assessed using proportional hazards models weighting observations by propensity to receive ESA treatment within a subset of anaemic patients with or without a regular transfusion need. Results ESA treatment (median duration of 27.5 months, range 0–77 months) was administered to 773 patients (45.6%). Outcomes were assessed in 897 patients (484 ESA treated and 413 untreated). ESA treatment was associated with a nonsignificant survival benefit ( HR 0.82, 95% CI: 0.65–1.04, P = 0.09); this benefit was larger amongst patients without prior transfusions ( P = 0.07). Amongst 539 patients for whom response to ESA treatment could be defined, median time to first post‐ ESA treatment transfusion was 6.1 months (IQR: 4.3–15.9 months) in those transfused before ESA treatment compared to 23.3 months (IQR: 7.0–47.8 months) in patients without prior transfusions ( HR 2.4, 95% CI: 1.7–3.3, P < 0.0001). Responding patients had a better prognosis in terms of a lower risk of death ( HR 0.65, 95% CI: 0.45–0.893, P = 0.018), whereas there was no significant effect on the risk of progression to acute myeloid leukaemia ( HR 0.71, 95% CI: 0.39–1.29, P = 0.27). Conclusion Appropriate use of ESA s can significantly delay the onset of a regular transfusion need in patients with lower‐risk MDS .