Differences in community and academic practice patterns for newly diagnosed myelodysplastic syndromes (MDS) patients

Abstract

Purpose The heterogeneous nature of myelodysplastic syndromes (MDS) complicates therapeutic decision making, particularly for newly diagnosed disease. Factors impacting the treatment plan in this early period of disease course are poorly defined. This study determines whether therapeutic choices for newly diagnosed MDS are associated with location of treatment (community or academic), prognostic risk category, and patient age. Methods The Adults in Minnesota with Myelodysplastic Syndromes (AIMMS) database was utilized in this statewide, prospective population-based study conducted by the University of Minnesota (UMN), Mayo Clinic, and Minnesota Department of Health. Adult (age 20+ years) cases of MDS newly diagnosed starting in April 2010 were invited to participate. This analysis includes patients enrolled during the first study year with one-year follow-up data. Treatment choices (supportive, active, and transplant) were stratified by the international prognostic scoring system (IPSS) and the revised-IPSS (IPSS-R), then separated into groups by location of care and age (<65 or 65+ years). Academic-based care was any contact with the UMN and Mayo Clinic; community-based care was all other clinical sites. Results Stratification by IPSS and IPSS-R showed supportive care decreased and active care increased with advancing risk categories (p <0.0001). Comparing treatment setting, community-based care had 77% supportive and 23% active treatment; academic-based care was 36% supportive, 41% active, and 23% transplant (p <0.0001). By age groups, patients <65 years with intermediate, high, or very high risk disease by IPSS-R received 97% active care/transplant, compared to only 52% of patients age 65+. Conclusions Younger patients and those treated at academic centers had a more aggressive treatment approach. Whether these treatment differences convey improved disease control and mortality, and therefore should be extended more frequently to older and community-based patients, is the subject of ongoing prospective study.

Factors predicting early mortality after new diagnosis of myelodysplastic syndrome: A population‐based study

“…A previous analysis of this cohort comparing treatment at academic to community centers has shown that care in an academic center results in more active treatment earlier in the disease course. 23 The increased mortality observed in our current expanded cohort in patients receiving care only in a community center may suggest that a less aggressive up-front approach to treatment may result in earlier death, especially for those with higher-risk features.…”

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

“…17 Given this information, one hypothesis to potentially explain our finding that education and income impacts the decision to pursue HCT is that education and income affect referral to an academic center and subsequently the aggressiveness of treatment. While difficult to determine in our small cohort, we performed an association analysis which revealed that those with less education appeared to receive their therapy at a community center more often than those with more education.…”

Time-dependent changes in mortality and transformation risk in MDS

“…Although our data are derived from untreated MDS patients, this is a representative patient cohort because the majority of MDS patients are still provided with supportive care without diseasemodifying treatment. 24,25 Future analysis of patients receiving treatment and comparison with the data presented herein are planned and may indicate the impact of therapy.…”