C001 Estimating the prevalence and pre-test likelihood of myelodysplasia: a retrospective review of bone marrow histopathology in 322 cases of unexplained cytopenia (s) in a teaching hospital

Buckstein, Rena; Jang, Kudo; Chesney, Alden; Reis, Marciano D.; Friedlich, Jessica; Zhang, L.

doi:10.1016/s0145-2126(07)70039-5

Leukemia Research

2007

DOI: 10.1016/s0145-2126(07)70039-5

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C001 Estimating the prevalence and pre-test likelihood of myelodysplasia: a retrospective review of bone marrow histopathology in 322 cases of unexplained cytopenia (s) in a teaching hospital

Rena Buckstein¹,

Kudo Jang²,

Alden Chesney³

et al.

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“…Myelodysplastic syndromes (MDS) are heterogeneous malignant myeloid stem cell disorders in adults with a median age of onset of 72 years. These haematological malignancies may affect as many as one in 1000 Canadians over the age of 65 years (Buckstein et al , ). MDS is characterized by ineffective haematopoiesis and peripheral blood cytopenias.…”

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Safety and efficacy of thrombopoietin‐receptor agonists in myelodysplastic syndromes: a systematic review and meta‐analysis of randomized controlled trials

2014

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SummaryThrombocytopenia is common (40-65%) and potentially serious in myelodysplastic syndromes (MDS). A systematic review was conducted to determine the safety and efficacy of adding a thrombopoietin-receptor (THPO-R) agonist to standard MDS treatment. MEDLINE, EMBASE and CENTRAL databases were searched. We included randomized controlled trials comparing a THPO-R agonist to placebo. A meta-analysis of the effects was performed. Endpoints included bleeding and platelet transfusion rates, risk of progression to acute myeloid leukaemia (AML) and mortality. Three hundred and eighty four patients from five trials were included, four using romiplostim and one using eltrombopag. Overall, the relative risk (RR) of bleeding with romiplostim versus placebo was 0Á84 [95% confidence interval (CI): 0Á57-1Á24]. However, compared to placebo, romiplostim significantly decreased the exposure-adjusted bleeding rate (RR 0Á92; 95% CI: 0Á86-0Á99), as well as the exposure-adjusted platelet transfusion rate (RR 0Á69; 95% CI: 0Á53-0Á88). The RR of AML progression with romiplostim was 1Á36 (95% CI: 0Á54-3Á40), however the outcome data were judged as higher risk of bias. Romiplostim is promising in its ability to decrease patient-important outcomes: bleeding and platelet transfusion need. Although the risk of AML progression was not increased, due to unclear risk of bias in the data, this safety concern is difficult to assess. Therefore, romiplostim cannot yet be routinely recommended. Early eltrombopag data is promising.Keywords: thrombopoietin, thrombopoiesis, thrombopoietin-receptor agonist, myelodysplastic syndromes .Myelodysplastic syndromes (MDS) are heterogeneous malignant myeloid stem cell disorders in adults with a median age of onset of 72 years. These haematological malignancies may affect as many as one in 1000 Canadians over the age of 65 years (Buckstein et al, 2007). MDS is characterized by ineffective haematopoiesis and peripheral blood cytopenias. While the development of acute myeloid leukaemia (AML) may occur, 75% of patients die prematurely from causes other than leukaemia. Thrombocytopenia, defined as a platelet count of <100 9 10 9 /l, is a common manifestation of MDS, affecting 40-65% of cases (Kantarjian et al, 2007). The International MDS risk analysis workshop (IMRAW) database identified 37% of MDS patients as thrombocytopenic at diagnosis (Greenberg et al, 1997). The MD Anderson Cancer Center (MDACC) group identified thrombocytopenia at referral in 67% of their MDS patients (Kantarjian et al, 2007). The thrombocytopenia was moderate (20-50 9 10 9 /l) in 26% of the patients and severe (<20 9 10 9 /l) in 17% of the patients, with differences in incidence seen based on the International Prognostic Scoring System (IPSS) risk classification (Kantarjian et al, 2007). Bleeding in MDS has been attributed to both thrombocytopenia and abnormal platelet function (Doll & List, 1989), with a reported incidence anywhere from 3% to 56% and ranging from minor bleeding, such as petechiae and gingival bleeding, to serious gastr...

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Safety and efficacy of thrombopoietin‐receptor agonists in myelodysplastic syndromes: a systematic review and meta‐analysis of randomized controlled trials

2014

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Iron overload in myelodysplastic syndromes: A Canadian consensus guideline

et al. 2008

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C001 Estimating the prevalence and pre-test likelihood of myelodysplasia: a retrospective review of bone marrow histopathology in 322 cases of unexplained cytopenia (s) in a teaching hospital

Cited by 2 publications

References 0 publications

Safety and efficacy of thrombopoietin‐receptor agonists in myelodysplastic syndromes: a systematic review and meta‐analysis of randomized controlled trials

Safety and efficacy of thrombopoietin‐receptor agonists in myelodysplastic syndromes: a systematic review and meta‐analysis of randomized controlled trials

Iron overload in myelodysplastic syndromes: A Canadian consensus guideline

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