Factors associated with hematopoietic cell transplantation (HCT) among patients in a population-based study of myelodysplastic syndrome (MDS) in Minnesota

Abstract

Myelodysplastic syndrome (MDS) is a clonal hematopoietic stem cell disorder characterized by dysplastic changes in the bone marrow, ineffective erythropoiesis and an increased risk of developing acute myeloid leukemia. Treatment planning for patients with MDS is a complex process and we sought to better characterize HCT outcomes and the factors that play into decision-making regarding referral of adults with MDS for definitive therapy with hematopoietic cell transplantation (HCT). Patients enrolled in a population based study of MDS between April 2010 and January 2013 who underwent HCT within the first year after enrollment were included in this analysis. Age and risk matched MDS patient controls also enrolled during that time period were used as a comparison. Survival was significantly better in the HCT group (48% vs. 21%, log-rank p-value 0.009). Non-HCT patients were more likely to have comorbidities and HCT patients were more likely to have a college degree and an income >$80,000. All three of these variables were independently associated with HCT, but none impacted survival. Patients with MDS in our study who underwent HCT had better survival than a comparable group of patients who did not undergo HCT. With refined treatment techniques more patients may be able to be considered for this therapy. More work needs to be done to determine why education and income appear to impact the decision to pursue HCT, but these factors may impact referral to an academic center where aggressive therapy like HCT is more likely to be considered.

Income, education and their impact on treatments and survival in patients with myelodysplastic syndromes

“…The findings on mortality are in line with the previous reported SEER data from the United States 11 . On a similar topic, three American studies on SCT have also found associations between survival among transplanted MDS patients and income 26‐28 . While it could be speculated that the differences in the American studies derive from differences in health insurance policies, our study was performed in a country where nearly all specialised care and medications are publically funded with minimal cost to the individual patient, and healthcare on equal conditions for the entire population is mandated by law.…”

Does quality of life impact the decision to pursue stem cell transplantation for elderly patients with advanced MDS?

“…36 Indeed, a recent population-based study in Minnesota found that, when comparing 33 MDS patients who underwent HCT to 32 age-and risk-matched MDS patient controls, HCT patients were more likely to have a college degree and have a higher income (P = 0.02 for both factors). 17 This disparity is likely due to the fact that referral to tertiary centers such as one of our two facilities is necessary for the procedure; however, our findings suggest that even after such a referral occurs, rates of potentially curative RIC HCT could still be improved. Patient factors, physician QOL and RIC HCT for MDS A El-Jawahri et al factors and donor availability all likely have roles in this disparity.…”

“…Candidate factors that likely impact this decision-making process include patient's age, disease course and severity, 17 QOL, patients' preferences with respect to the relative utility of being cured versus risk of transplant and burden of prolonged treatments, donor availability, and clinicians' perception of patients' QOL and functional status. Elucidating these factors is instrumental to address barriers to RIC HCT in this population with potentially curable disease, and to delineate important considerations that may be overlooked in the decision-making process.…”

GPX3 methylation is associated with hematologic improvement in low-risk myelodysplastic syndrome patients treated with Pai-Neng-Da

“… 4 , 5 Therapeutic strategies for low-risk MDS include red blood cell (RBC) infusion and iron chelation therapy, the combined use of hematopoietic growth factors and immunosuppressive agents, and androgen-assisted therapy, but the response to these treatments is unsatisfactory. 5 – 7 …”

“…4,5 Therapeutic strategies for low-risk MDS include red blood cell (RBC) infusion and iron chelation therapy, the combined use of hematopoietic growth factors and immunosuppressive agents, and androgen-assisted therapy, but the response to these treatments is unsatisfactory. [5][6][7] Numerous studies have shown that glutathione peroxidase is involved in the development and progression of many tumors. 8,9 Glutathione peroxidase 3 (GPX3) is the most widely studied member of the GPX family.…”