Erythropoiesis-stimulating agents are not associated with increased risk of thrombosis in patients with myelodysplastic syndromes

Smith, Sheila Weiss; Sato, Masayo; Gore, Steven D.; Ke, Xuehua; McNally, Diane; Davidoff, Amy J.

doi:10.3324/haematol.2011.051755

Cited by 35 publications

(25 citation statements)

References 21 publications

(20 reference statements)

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“…iron or folate deficiency) or other causes (gastrointestinal bleeding) as contributing factors to anemia in MDS patients and to correct these factors if present [39]. The concerns of increased venous thromboembolism rates with ESA therapy in patients with solid tumors have not been substantiated in patients with MDS receiving ESAs [51]. …”

Section: Treatment Of Lr-mdsmentioning

confidence: 99%

Current therapy of myelodysplastic syndromes

2013

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After being a neglected and poorly-understood disorder for many years, there has been a recent explosion of data regarding the complex pathogenesis of myelodysplastic syndromes (MDS). On the therapeutic front, the approval of azacitidine, decitabine, and lenalidomide in the last decade was a major breakthrough. Nonetheless, the responses to these agents are limited and most patients progress within 2 years. Allogeneic stem cell transplantation remains the only potentially curative therapy, but it is associated with significant toxicity and limited efficacy. Lack or loss of response after standard therapies is associated with dismal outcomes. Many unanswered questions remain regarding the optimal use of current therapies including patient selection, response prediction, therapy sequencing and combinations, and management of resistance. It is hoped that the improved understanding of the underpinnings of the complex mechanisms of pathogenesis will be translated into novel therapeutic approaches and better prognostic/predictive tools that would facilitate accurate risk-adaptive therapy.

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Section: Treatment Of Lr-mdsmentioning

confidence: 99%

Current therapy of myelodysplastic syndromes

2013

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“…Thrombotic events are rare, especially arterial thrombosis. A cohort of 5,673 MDS patients showed 212 incidents of DVT [3], and the incidence of arterial thrombosis in MDS was uncertain. However, clinically significant arterial thrombotic complications are possible, as in the present case.…”

Section: Discussionmentioning

confidence: 99%

Acute Cerebral Infarction as a Rare Thrombotic Event in Myelodysplastic Syndrome: A Case Report

et al. 2016

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Myelodysplastic syndrome (MDS) is a bone marrow failure syndrome characterized by cytopenia that results in high risks of infection and bleeding. However, there are few reports of cerebral infarction in MDS. We reported a 72-year-old female with MDS who developed acute cerebral infarction. Clinical history of the patient revealed no definite risk factors for stroke except diabetes mellitus and dyslipidemia that was well controlled. This case represented the rare occurrence of arterial thrombosis causing acute cerebral infarction in MDS, which may be due to complex chromosomal abnormality and inflammatory processes.

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“…13,28 During treatment with ESAs, MDS lower-risk patients did not experience an increase of thrombotic events compared with nontreated patients, 29 quite different to what was observed for other hematologic neoplasias. It is therefore not necessary to establish any antithrombotic therapy, unless in the presence of thrombophilia.…”

Section: Treatment Of Anemiamentioning

confidence: 95%

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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Erythropoiesis-stimulating agents are not associated with increased risk of thrombosis in patients with myelodysplastic syndromes

Cited by 35 publications

References 21 publications

Current therapy of myelodysplastic syndromes

Current therapy of myelodysplastic syndromes

Acute Cerebral Infarction as a Rare Thrombotic Event in Myelodysplastic Syndrome: A Case Report

Treatment of low-risk myelodysplastic syndromes

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