Effects of Erythropoiesis-Stimulating Agents on Overall Survival of IPSS Low/INT-1 Risk Transfusion Independent Myelodysplastic Syndrome Patients, a FISM Study

Messa, Emanuela; Gioia, Daniela; Masiera, Elisa; Castiglione, A.; Ceccarelli, Marco; Salvi, Flavia; Danise, Paolo; Sanna, Alessandro; Allione, Bernardino; Balleari, Enrico; Poloni, Antonella; Cametti, Gianni; Ferrero, Dario; Tassara, Rodolfo; Finelli, Carlo; Bonferroni, Margherita; Ciccone, G; Saglio, G; Levis, Alessandro

doi:10.1016/s0145-2126(17)30206-0

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“…Our results are consistent with previous ones indicating longer OS in MDS patients who achieve HI‐E, at whichever rhEPO doses used . We recently demonstrated that a trend for survival advantage is present for MDS patients with isolated erythroid dysplasia (RA/RARS/del5q) receiving ESAs for severe‐moderate anemia (8‐10 g/dL) …”

Section: Discussionsupporting

confidence: 92%

“…8,9 We recently demonstrated that a trend for survival advantage is present for MDS patients with isolated erythroid dysplasia (RA/RARS/del5q) receiving ESAs for severe-moderate anemia (8-10 g/dL). 28 Treatment with rhEPO-irrespectively of the doses used-do not have significant impact on progression to AML, which was higher among MDS patients not responding to rhEPO, transfusion-dependent patients and with higher IPSS-R risk scores, confirming previous results. 29,30 In conclusion, although with the limits of a retrospective analysis and a relatively limited number of cases, our study indicates that the SD of rhEPO is as effective as HD in improving anemia in MDS patients stratified according to the propensity score of treatment, with the exception of transfusion-dependent patients and with higher IPSS-R risk scores.…”

Section: Discussionsupporting

confidence: 84%

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Effects of different doses of erythropoietin in patients with myelodysplastic syndromes: A propensity score‐matched analysis

et al. 2019

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Background Erythropoiesis‐stimulating agents effectively improve the hemoglobin levels in a fraction of anemic patients with myelodysplastic syndromes (MDS). Higher doses (HD) of recombinant human erythropoietin (rhEPO) have been proposed to overcome suboptimal response rates observed in MDS patients treated with lower “standard doses” (SD) of rhEPO. However, a direct comparison between the different doses of rhEPO is lacking. Methods A cohort of 104 MDS patients treated with HD was retrospectively compared to 208 patients treated with SD in a propensity score‐matched analysis to evaluate hematological improvement‐erythroid (HI‐E) rate induced by the different doses of rhEPO. The impact of rhEPO doses on survival and progression to leukemia was also investigated. Results Overall HI‐E rate was 52.6%. No difference was observed between different rhEPO doses (P = .28) in matched cohorts; in a subgroup analysis, transfusion‐dependent patients and patients with higher IPSS‐R score obtained a higher HI‐E rate with HD, although without significant impact on overall survival (OS). Achievement of HI‐E resulted in superior OS. At univariate analysis, a higher HI‐E rate was observed in transfusion‐independent patients (P < .001), with a lower IPSS‐R score (P < .001) and lower serum EPO levels (P = .027). Multivariate analysis confirmed that rhEPO doses were not significantly related to HI‐E (P = .26). There was no significant difference in OS or progression to leukemia in patients treated with HD vs SD. Conclusion SD are substantially equally effective to HD to improve anemia and influencing survival in MDS patients stratified according to similar propensity to be exposed to rhEPO treatment.

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Section: Discussionsupporting

confidence: 92%