The impact of age on the diagnosis and therapy of myelodysplastic syndromes: results from a retrospective multicenter analysis in Germany

Abstract

Myelodysplastic syndromes (MDS) is a disease of predominantly elderly patients with a median age of >70 yrs. However, data on the management of these patients outside of clinical trials are scarce. To assess patterns of MDS management in routine patient care with regard to the impact of age, we conducted a multicenter, representative survey of MDS health services in Germany. Data of 269 patients treated at 57 institutions were collected from preplanned chart reviews and were analyzed retrospectively. At diagnosis, median age was 70 yrs, 50% of patients had a Karnofsky index (KI) of 90%, and 12% had a comorbidity index ≥ 3 according to Sorror et al. (J Clin Oncol, 25, 2007, 4246). Cytogenetic analysis and International Prognostic Scoring System (IPSS) risk assessment were performed significantly less frequently in patients >75 yrs than in patients ≤ 75 yrs (P < 0.001 and P = 0.019). In bivariate analysis, potential predictors for performing IPSS risk assessment were age ≤ 75 yrs (y/n, P = 0.019), diagnosis at a university hospital (y/n, P = 0.001), WHO subtypes RCUD (y/n, P = 0.028), RARS (y/n, P = 0.002), or RAEB II (y/n, P = 0.037). Patients ≤ 75 yrs were more likely to receive active therapies (i.e., chemotherapy, immunomodulatory therapy, or epigenetic therapy) than patients >75 yrs (51% vs. 37%, P = 0.007). In bivariate analysis age ≤ 75 yrs (y/n, P = 0.007) was a significant predictor for active treatment with no correlation with the other predictors [IPSS risk score int-2 or high (y/n, P = 0.005), WHO subtypes RCUD (y/n, P < 0.001), RCMD (y/n, P = 0.003), RAEB II (y/n, P < 0.001), or CMML I (y/n, P = 0.020)]. This survey confirms the impact of age on the thoroughness of MDS diagnosis and the decision for active treatment. As cytogenetic analysis and risk assessment are essential for the choice of appropriate therapy, elderly patients in particular may not be receiving adequate treatment.

Non-hematologic predictors of mortality improve the prognostic value of the international prognostic scoring system for MDS in older adults

“…However, there is evidence that older MDS patients are less likely than younger patients to undergo risk stratification prior to treatment with chemotherapy in routine clinical practice. 20 The National Comprehensive Cancer Network recommends assessment of comorbidities, geriatric syndromes and frailty into the routine care of older cancer patients with any cancer diagnosis. 21 Available evidence supports comprehensive geriatric assessment as the most evidence-based method of detecting and quantifying fitness for therapy in cancer care.…”

Efficacy, safety and pharmacokinetics of subcutaneous azacitidine in Chinese patients with higher risk myelodysplastic syndromes: Results from a multicenter, single‐arm, open‐label phase 2 study

“…13 The estimated prevalence of MDS in China is 1.5/100 000 persons. 1 Compared with Western patients, Chinese patients tend to be younger; reported median ages at diagnosis in different Chinese MDS patient cohorts range from 49 to 62 years, 1,14-16 compared with median ages ≥70 years 17 for Western patients. Differences in population ages can influence drug metabolism and toxicity.…”

Safety and efficacy of azacitidine in Belgian patients with high-risk myelodysplastic syndromes, acute myeloid leukaemia, or chronic myelomonocytic leukaemia: results of a real-life, non-interventional post-marketing survey

“…[1][2][3][4] The median age at MDS diagnosis is §70 years. [5][6][7] MDS prognosis depends on disease risk features assessed by the International Prognostic Scoring System (IPSS): patients with low or intermediate-1 (Int-1) IPSS scores have a median overall survival (OS) of several years, whereas patients with intermediate-2…”