Daily practice management of myelodysplastic syndromes in France: data from 907 patients in a one-week cross-sectional study by the Groupe Francophone des Myelodysplasies

Abstract

BackgroundThere is little published information on the everyday clinical management of myelodysplastic syndromes in real world practice. Design and MethodsWe conducted a cross-sectional study of all patients with myelodysplastic syndromes attending 74 French centers in a 1-week period for inpatient admission, day-hospital care or outpatient visits. ResultsNine hundred and seven patients were included; 67.3% had lower-risk myelodysplastic syndromes (International Prognostic Scoring System: low or intermediate-1). Karyotype had been analyzed in 82.5% of the cases and was more often of intermediate or poor risk in patients under 65 years old compared with those who were older. Red blood cell transfusions accounted for as many as 31.4% of the admissions. Endogenous erythropoietin level was less than 500 IU/L in 88% of the patients tested. Erythroid stimulating agents had been or were being used in 36.8% of the lower risk patients, iron chelation in 31% of lower risk patients requiring red blood cell transfusions and lenalidomide in 41% of lower risk patients with del 5q. High-dose chemotherapy, hypomethylating agents, low dose cytarabine and allogeneic stem cell transplantation had been or were being used in 14.8%, 31.1%, 8.8% and 5.1%, respectively, of higher-risk patients. ConclusionsKaryotype is now assessed in most patients with myelodysplastic syndromes, and patients under 65 years old may have more aggressive disease. Apart from erythroid-stimulating agents and, in higher-risk myelodysplastic syndromes, hypomethylating agents, specific treatments are used in a minority of patients with myelodysplastic syndromes and red blood cell transfusions still represent the major reason for hospital admission.Key words: MDS, cross-sectional study, outpatient visit, erythropoietin, erythropoiesis stimulating agents. Citation: Kelaidi C, Stamatoullas A, Beyne-Rauzy O, Raffoux E, Quesnel B, Guerci A, Dreyfus F, Brechignac S, Berthou C, Prebet T, Hicheri Y, Hacini M, Delaunay J, Gourin M-P , Camo J-M, Zerazhi H, Taksin A-L, Legros L, Choufi B, and Fenaux P, on behalf of the Groupe Francophone des Myélodysplasies (GFM). Daily practice management of myelodysplastic syndromes in France:data from 907 patients in a one-week cross-sectional study by the Groupe Francophone des Myélodysplasies. Haematologica. 2010;95:892-899. doi:10.3324/haematol.2009

Diagnosis and Therapy of Myelodysplastic Syndromes in Germany: A Retrospective Multicenter Analysis

“…However,only17%ofthesepatientsreceivedESAs,andthe majorityweregivenredbloodcelltransfusions.IntheFrench studypublishedbyKelaidietal. [17],77%ofpatientshada hemoglobinvaluebelow10g/dlatdiagnosisorinclusion.52% ofthesepatientsreceivedESAsand48%redbloodcelltrans-fusions only. Transfusion dependence in MDS is associated withasignificantdecreaseinsurvival [15],mainlyduetothe clinical complications of bone marrow failure (including hemorrhage,infections,andthedebilitatingeffectsofchronic anemia), and/or to complications of transfusion-related iron overload.…”

“…Onkologie2012;35: [350][351][352][353][354][355][356] DiagnosticandTherapeuticPractice ofMDSinGermany 351 dailyclinicalpractice.Sofar,thereareonlyfewreportsonthe daily practice management of MDS [16,17]. Therefore, in 2010, a retrospective survey was conducted in Germany.…”

“…Distributionofage,gender,anddiseasestagescorrespondwelltopreviouslypublisheddata [16,17].IntheUSanalysisbySekeres et al [16], median age at diagnosis was 71 years, with 55% malesandcomparableFABandWHOdiseasestages.Inthe French study published by Kelaidi et al [17], patients were slightly older (median age 74 years), and the percentage of patients with advanced disease (i.e., FAB RAEB, and RAEB-t)wasslightlyhigher.Theauthorsexplainthisbythe modeofaccrualintheFrenchcross-sectionalstudywhichhad anoverrepresentationofpatientsinneedoftreatment.…”

Anemia as the Main Manifestation of Myelodysplastic Syndromes

“…Still, one third of MDS patients are seen in clinics solely due to the need of transfusions. 51 RBC transfusions are at present certainly quite safe: the risk of death from transfusion is 3.1/million, with most deaths due to transfusion-associated circulatory overload (67%). The risk of major morbidity is also low (46.5/million) and most often due to acute transfusion reactions (allergic, hypotensive, and febrile).…”

“…More than 80% of them will finally require red blood cell (RBC) transfusions. 51 Transfusions have been, and sometimes still are, the mainstay of chronic anemia therapy. Still, one third of MDS patients are seen in clinics solely due to the need of transfusions.…”