Early introduction of ESA in low risk MDS patients may delay the need for RBC transfusion: A retrospective analysis on 112 patients

Park, Sophie; Kelaïdi, Charikleia; Sapena, Rosa; Vassilieff, D.; Beyne‐Rauzy, Odile; Coiteux, Valérie; Vey, Norbert; Ravoet, Christophe; Chèze, Stéphane; Rosé, Christian; Legros, Laurence; Stamatoullas, Aspasia; Escoffre‐Barbe, Martine; Guerci, Agnès; Chaury, M.P.; Fenaux, Pierre; Dreyfus, François

doi:10.1016/j.leukres.2010.05.030

Cited by 60 publications

(54 citation statements)

References 23 publications

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“…Regarding higher dosages of ESAs, several trials reported rates of erythroid response of 50%-71% in lower-risk MDS patients treated with high doses of rHuEpo (60,000 -80,000 U/wk) [32,33] (3,334 and 3,435) or darbepoetin (300 mcg once weekly or 500 g every 2-3 weeks) (3,536). Quite recently, it became evident that earlier inception of ESA therapy may delay the need for transfusion and substantially increase, for a longer period, the hemoglobin level (63.1% response rate) [37]. On the other hand, it has been well known for some time that a longer duration of ESA treatment may recruit later responders, with a significant difference in the rate of response at 26 weeks versus 12 weeks [38].…”

Section: Clinical Efficacymentioning

confidence: 99%

Clinical Use of Erythropoietic Stimulating Agents in Myelodysplastic Syndromes

Santini

2011

The Oncologist

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Section: Clinical Efficacymentioning

confidence: 99%

Clinical Use of Erythropoietic Stimulating Agents in Myelodysplastic Syndromes

Santini

2011

The Oncologist

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“…24 Provided endogenous EPO is measured and is below 500 U/L (see section to follow), treatment with ESAs should start in a timely manner, before transfusion-dependence is established, because the probability to respond is higher for early treated, transfusionindependent patients. 25 Response to ESAs is generally observed within 12 weeks 17 and should not be evaluated before then to avoid missing some cases that show later increases of Hb. Together with optimal doses and periods of treatment, it is important to administer ESAs regularly and without interruptions in order to maintain stable levels of Hb, whose target values are 12 g/dL, traditionally derived from recommendations regarding renal-insufficient and solid tumor patients.…”

Section: Treatment Of Anemiamentioning

confidence: 99%

Treatment of low-risk myelodysplastic syndromes

Santini

2016

Hematology

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The majority of myelodysplastic syndrome (MDS) patients belong to the International Prognostic Scoring System (IPSS) and IPSS-revised (IPSS-R) lower-risk categories. Their precise diagnostics and prognostic stratification is often a challenge, but may ensure the optimization of therapy. The availability of diverse treatment options has significantly improved the quality of life and survival of this group of patients. Anemia is the most relevant cytopenia in terms of frequency and symptoms in lower-risk MDS, and may be treated successfully with erythropoietic stimulating agents, provided a careful selection is performed on the basis of IPSS-R, endogenous erythropoietin levels, and transfusion independence. Doses and duration of therapy of erythropoietic-stimulating agents (ESAs) are critical to determine efficacy. In case a patient fails ESA treatment, the available options may include lenalidomide (approved for del5q positive cases), hypomethylating agents, and a rather large number of experimental agents, whose clinical trials should be offered to a larger number of MDS patients. The choice for second-line treatment must take into account biologic, cytogenetic, and molecular-identified characteristics of individual patients, as well as frailty and comorbidities. Other cytopenias are less frequently presenting as isolated. Specific therapy for thrombocytopenia has been proposed in experimental clinical trials with thrombomimetic agents that have shown good efficacy, but raised some safety concern. Although neutropenia is targeted symptomatically with growth factor supportive care, the immunosuppressive treatments are indicated mainly for pancytopenic, hypoplastic lower-risk MDS; they are not widely used because of their toxicity, despite the fact that they may induce responses. Finally, hematopoietic stem cell transplant is the curative option also for lower-risk MDS and timing should be carefully evaluated, balancing toxicity and the possibility of survival advantage. Finally, even when considered suitable for lower-risk MDS, transplant application is limited to the rarer fit and younger MDS patient.

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“…A flow cytometry-based prediction model that combined information on expression of lineage infidelity markers with pretreatment EPO levels defined three cohorts with 94, 17, and 11 % ESA response probability [13•]. The Groupe Francophone des Myélodysplasies (GFM) experience with 403 patients treated between 1998 and 2006 showed significantly higher response rates with epoetin, epoetin plus G-CSF, and darbepoetin in patients with <10 % marrow blasts, IPSS lower-risk disease (low-and intermediate-1 risk), RBC transfusion independence, serum EPO <200 U/L, and a shorter time from diagnosis to treatment [14]. Earlier introduction of ESAs led to higher hemoglobin levels that were maintained for longer durations, thereby delaying the need for transfusion.…”

Section: Response and Efficacy Of Esasmentioning

confidence: 99%

Resuscitating a Dying Marrow: the Role of Hematopoietic Growth Factors

Pandita

Mukherjee

2014

Curr Hematol Malig Rep

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The treatment landscape for myelodysplastic syndromes (MDS) has evolved over the last two decades, with a better understanding of the disease pathophysiology and the use of newer or combination therapies. For lower-risk MDS patients, hematopoietic growth factors have continued to be the mainstay of therapy. However, better patient selection criteria and decision tools to predict responses have made these therapies more beneficial to patients. As the range of newer drugs continues to expand in our treatment armamentarium for lower-risk MDS, questions still remain regarding the safety of these drugs with long-term use. This review will discuss the role of growth factors in MDS, focusing on dosing and combination strategies to improve responses, selecting the appropriate patient population, and recognizing the safety profile based on evidence from published literature.

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Early introduction of ESA in low risk MDS patients may delay the need for RBC transfusion: A retrospective analysis on 112 patients

Cited by 60 publications

References 23 publications

Clinical Use of Erythropoietic Stimulating Agents in Myelodysplastic Syndromes

Clinical Use of Erythropoietic Stimulating Agents in Myelodysplastic Syndromes

Treatment of low-risk myelodysplastic syndromes

Resuscitating a Dying Marrow: the Role of Hematopoietic Growth Factors

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