101
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Abou Zahr A, Bernabe Ramirez C, Wozney J, Prebet T, Zeidan AM. New Insights into the Pathogenesis of MDS and the rational therapeutic opportunities. Expert Rev Hematol 2016; 9:377-88. [DOI: 10.1586/17474086.2016.1135047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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102
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Desborough M, Estcourt LJ, Chaimani A, Doree C, Hopewell S, Trivella M, Hadjinicolaou AV, Vyas P, Stanworth SJ. Alternative agents versus prophylactic platelet transfusion for preventing bleeding in patients with thrombocytopenia due to chronic bone marrow failure: a network meta-analysis and systematic review. Cochrane Database Syst Rev 2016; 2016:CD012055. [PMID: 27069420 PMCID: PMC4826602 DOI: 10.1002/14651858.cd012055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To compare the relative efficacy of different treatments for thrombocytopenia (artificial platelet substitutes, platelet-poor plasma, fibrinogen, rFVIIa, rFXIII, thrombopoietin mimetics, antifibrinolytic drugs or platelet transfusions) in patients with chronic bone marrow failure and to derive a hierarchy of potential alternate treatments to platelet transfusions.
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Affiliation(s)
| | - Lise J Estcourt
- Haematology/Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
| | - Anna Chaimani
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Carolyn Doree
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Sally Hopewell
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | | | - Andreas V Hadjinicolaou
- Human Immunology Unit, Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Paresh Vyas
- MRC Molecular Haematology Unit and Department of Haematology, University of Oxford and Oxford University Hospitals NHS Trust, Oxford, UK
| | - Simon J Stanworth
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Oxford, UK
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103
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Porter JB, de Witte T, Cappellini MD, Gattermann N. New insights into transfusion-related iron toxicity: Implications for the oncologist. Crit Rev Oncol Hematol 2015; 99:261-71. [PMID: 26806144 DOI: 10.1016/j.critrevonc.2015.11.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 09/28/2015] [Accepted: 11/24/2015] [Indexed: 01/19/2023] Open
Abstract
Iron overload is a potentially life-threatening consequence of multiple red-blood-cell transfusions. Here, we review factors affecting excess iron distribution and its damage to specific tissues, as well as mechanisms of oncogenesis by iron. Although consequences of transfusional iron overload are best described in thalassemia major and related inherited anemias, they are increasingly recognized in acquired conditions, such as myelodysplastic syndromes (MDS). Iron overload in MDS not only impacts on certain tissues, but may affect the clonal evolution of MDS through generation of reactive oxygen species. Iron overload may also influence hematopoietic-stem-cell-transplantation outcomes. Novel MRI methods for assessing body iron have impacted significantly on outcome in inherited anemias by allowing monitoring of iron burden and iron chelation therapy. This approach is increasingly being used in MDS and stem-cell-transplant procedures. Knowledge gained from managing transfusional iron overload in inherited anemias may be translated to general oncology, with potential for improved patient outcomes.
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Affiliation(s)
- John B Porter
- Department of Haematology, University College London, UCL Cancer Institute, Paul O'Gorman Building, 72 Huntley Street, London WC1E 6BT, UK.
| | - Theo de Witte
- Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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104
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Gu Y, Estcourt LJ, Doree C, Hopewell S, Vyas P. Comparison of a restrictive versus liberal red cell transfusion policy for patients with myelodysplasia, aplastic anaemia, and other congenital bone marrow failure disorders. Cochrane Database Syst Rev 2015; 2015:CD011577. [PMID: 26436602 PMCID: PMC4650197 DOI: 10.1002/14651858.cd011577.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Bone marrow failure disorders include a heterogenous group of disorders, of which myelodysplastic syndrome (MDS), forms the largest subgroup. MDS is predominantly a disease of the elderly, with many elderly people managed conservatively with regular allogeneic red blood cell (RBC) transfusions to treat their anaemia. However, RBC transfusions are not without risk. Despite regular transfusions playing a central role in treating such patients, the optimal RBC transfusion strategy (restrictive versus liberal) is currently unclear. OBJECTIVES To assess the efficacy and safety of a restrictive versus liberal red blood cell transfusion strategy for patients with myelodysplasia, acquired aplastic anaemia, and other inherited bone marrow failure disorders. SEARCH METHODS We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 4), Ovid MEDLINE (from 1946), Ovid EMBASE (from 1974), EBSCO CINAHL (from 1937), the Transfusion Evidence Library (from 1980) and ongoing trial databases to 26th May 2015. SELECTION CRITERIA RCTs including patients with long-term bone marrow failure disorders that require allogeneic blood transfusion, who are not being actively treated with a haematopoietic stem cell transplant, or intensive chemotherapy. DATA COLLECTION AND ANALYSIS We used standard Cochrane review methodology. One author initially screened all references, and excluded any that were clearly irrelevant or duplicates. Two authors then independently screened all abstracts of articles, identified by the review search strategy, for relevancy. Two authors independently assessed the full text of all potentially relevant articles for eligibility, completed the data extraction and assessed the studies for risk of bias using The Cochrane Collaboration's 'Risk of bias' tool. MAIN RESULTS We included one trial (13 participants) and identified three ongoing trials that assess RBC transfusion strategies in people with MDS.The quality of the evidence was very low across different outcomes according to GRADE methodology.The one included study randomised participants to a restrictive [haemoglobin (Hb) transfusion trigger < 72 g/L, 8 participants] or liberal [Hb trigger < 96 g/L, 5 participants] transfusion policy. There was insufficient evidence to determine a difference in all-cause mortality (1 RCT; 13 participants; RR 0.13, 95% CI 0.01 to 2.32; very low quality evidence). There was insufficient evidence to determine a difference in the number of red blood cell transfusions (1 RCT; 13 participants; 1.8 units per patient per month in the liberal group, compared to 0.8 in the restrictive arm, no standard deviation was reported; very low quality evidence). There were no anaemia-related complications reported (cardiac failure) and no reported effect on activity levels (no statistics provided). The study did not report: mortality due to bleeding/infection/transfusion reactions or iron overload, quality of life, frequency and length of hospital admissions, serious infections (requiring admission to hospital), or serious bleeding (e.g. WHO/CTCAE grade 3 (or equivalent) or above). AUTHORS' CONCLUSIONS This review indicates that there is currently a lack of evidence for the recommendation of a particular transfusion strategy for bone marrow failure patients undergoing supportive treatment only. The one RCT included in this review was only published as an abstract and contained only 13 participants. Further randomised trials with robust methodology are required to develop the optimal transfusion strategy for such patients, particularly as the incidence of the main group of bone marrow failure disorders, MDS, rises with an ageing population.
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Affiliation(s)
- Yisu Gu
- NHS/ University of OxfordHaematologyHeadley Way,HeadingtonOxfordOxfordshireUKOX3 9DU
| | - Lise J Estcourt
- NHS Blood and TransplantHaematology/Transfusion MedicineLevel 2, John Radcliffe HospitalHeadingtonOxfordUKOX3 9BQ
| | - Carolyn Doree
- NHS Blood and TransplantSystematic Review InitiativeJohn Radcliffe HospitalOxfordUKOX3 9BQ
| | - Sally Hopewell
- University of OxfordCentre for Statistics in MedicineWolfson CollegeLinton RoadOxfordOxfordshireUKOX2 6UD
| | - Paresh Vyas
- University of Oxford and Oxford University Hospitals NHS TrustMRC Molecular Haematology Unit and Department of HaematologyWeatherall Institute of Molecular Medicine, John Radcliffe HospitalOxfordOxfordshireUKOX3 9DS
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105
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Belli CB, Pinheiro RF, Bestach Y, Larripa IB, da Silva Tanizawa RS, Alfonso G, Gonzalez J, Rosenhain M, Watman N, Cavalcante de Andrade Silva M, Negri Aranguren P, García Rivello H, Magalhaes SM, Valladares X, Undurraga MS, Velloso ER. Myelodysplastic syndromes in South America: a multinational study of 1080 patients. Am J Hematol 2015; 90:851-8. [PMID: 26104573 DOI: 10.1002/ajh.24097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 06/18/2015] [Accepted: 06/19/2015] [Indexed: 01/23/2023]
Abstract
There are previously reported data describing differences between Asian and European patients with Myelodysplastic Syndromes (MDS), few direct comparisons based on cancer registration characteristics or using cohorts to validate scoring systems. This is the first study from South-America, which attempts to describe demographic, clinical features, and outcome of MDS patients. We retrospectively analyzed 1,080 patients with de novo MDS from Argentina (635), Brazil (345), and Chile (100). Chilean patients were younger (P = 0.001) with female preponderance (P = 0.071). Brazilian series showed a higher predominance of RARS subtype regarding FAB and WHO classifications (P < 0.001). Hemoglobin levels were significantly lower in Brazilian and Chilean series (P < 0.001), and Chilean series also showed a lower platelet count (P = 0.028), with no differences concerning the neutrophil count, % BM blast, and the distribution of cytogenetic risk groups (P > 0.05). Chilean series depicted a lower overall survival (OS; 35 months vs. 56 months-Argentine; 55 months-Brazil, P = 0.030), which was consistent with a higher predominance of the high-risk group according both to the IPSS and IPSS-R (P = 0.046 and P < 0.001). The IPSS-R system and its variables showed a good reproducibility to predict clinical outcome for the whole South-American population. Epidemiological and clinical characteristics, distribution among prognostic subgroups, the OS, and the access to disease modifying therapies were more similar between Argentinean and Brazilian compared with Chilean MDS series. This will need further analysis in a larger group of patients. Descriptive and comparative studies are necessary to establish epidemiological features useful for public health attitudes to generate suitable therapeutic schemes.
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Affiliation(s)
- Carolina B. Belli
- Instituto de Medicina Experimental (IMEX-CONICET)/Academia Nacional de Medicina; Laboratorio de Genética Hematológica; Buenos Aires Argentina
- On behalf of the Grupo de Estudio de SMD, Sociedad Argentina de Hematología; Buenos Aires Argentina
| | | | - Yesica Bestach
- Instituto de Medicina Experimental (IMEX-CONICET)/Academia Nacional de Medicina; Laboratorio de Genética Hematológica; Buenos Aires Argentina
| | - Irene B. Larripa
- Instituto de Medicina Experimental (IMEX-CONICET)/Academia Nacional de Medicina; Laboratorio de Genética Hematológica; Buenos Aires Argentina
| | | | - Graciela Alfonso
- Servicio de Hematología; Hospital General de Agudos “A. J. Posadas”; El Palomar Argentina
- On behalf of the Grupo de Estudio de SMD, Sociedad Argentina de Hematología; Buenos Aires Argentina
| | - Jacqueline Gonzalez
- Servicio de Hematología, Hospital General de Agudos “C Durand,”; Buenos Aires Argentina
- On behalf of the Grupo de Estudio de SMD, Sociedad Argentina de Hematología; Buenos Aires Argentina
| | - Mariana Rosenhain
- Servicio de Hematología; Hospital General de Agudos “Tornú,”; Buenos Aires Argentina
- On behalf of the Grupo de Estudio de SMD, Sociedad Argentina de Hematología; Buenos Aires Argentina
| | - Nora Watman
- Servicio de Hematología; Hospital General de Agudos “Ramos Mejía,”; Buenos Aires Argentina
| | | | | | - Hernán García Rivello
- Servicio de Patología; Hospital Italiano de, Buenos Aires; Argentina
- On behalf of the Grupo de Estudio de SMD, Sociedad Argentina de Hematología; Buenos Aires Argentina
| | | | | | | | - Elvira R.P. Velloso
- Hematology and Transfusion Medicine; Hospital Das Clinicas, University of Sao Paulo; Brazil
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106
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Abstract
Since 2001, cases of myelodysplastic syndromes (MDSs) have been tracked by cancer registries. Examining registry data in the USA, the reported age-adjusted incidence of MDS per 100,000 was 3.3 per year for 2001-2003 and 4.9 per year for 2007-2011, with increases likely a result of growing awareness of reporting requirements. However, active case-finding methods repeatedly demonstrate that population-based registries have underestimated the incidence of MDS due to underreporting and underdiagnosis. Using keyword search strategies of electronic pathology reports or other novel case capture methods, the true incidence of MDS has been estimated between 5.3 and 13.1 per 100,000. Using Medicare billing claims data, the incidence of MDS per 100,000 in patients aged ≥65 years has been estimated between 75 and 162. MDS prevalence is estimated to be 60,000 and -170,000 in the USA and projected to grow. Epidemiologic data can help estimate the burden of MDS and expose unmet clinical needs. For example, patients with MDS receiving transfusions had significantly higher reported health care costs versus those that did not (3-year mean of $88,824 vs $29,519). Epidemiologic data also revealed that most MDS patients receiving transfusions do not receive active therapies, despite strong evidence that hypomethylating agents and lenalidomide significantly reduce transfusion burden. Other unmet needs identified by epidemiologic studies include high need for treatment options after failing first-line therapy and shared decision making by older MDS patients.
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Affiliation(s)
- Christopher R Cogle
- Division of Hematology and Oncology, Department of Medicine, College of Medicine, University of Florida, 1600 SW Archer Road, Box 100278, Gainesville, FL, 32610-0278, USA,
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107
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Petrou E, Mavrogeni S, Karali V, Kolovou G, Kyrtsonis MC, Sfikakis PP, Panayiotidis P. The role of magnetic resonance imaging in the evaluation of transfusional iron overload in myelodysplastic syndromes. Rev Bras Hematol Hemoter 2015; 37:252-8. [PMID: 26190429 PMCID: PMC4519711 DOI: 10.1016/j.bjhh.2015.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 03/03/2015] [Accepted: 03/31/2015] [Indexed: 12/23/2022] Open
Abstract
Myelodysplastic syndromes represent a group of heterogeneous hematopoietic neoplasms derived from an abnormal multipotent progenitor cell, characterized by a hyperproliferative bone marrow, dysplasia of the cellular hemopoietic elements and ineffective erythropoiesis. Anemia is a common finding in myelodysplastic syndrome patients, and blood transfusions are the only therapeutic option in approximately 40% of cases. The most serious side effect of regular blood transfusion is iron overload. Currently, cardiovascular magnetic resonance using T2 is routinely used to identify patients with myocardial iron overload and to guide chelation therapy, tailored to prevent iron toxicity in the heart. This is a major validated non-invasive measure of myocardial iron overloading and is superior to surrogates such as serum ferritin, liver iron, ventricular ejection fraction and tissue Doppler parameters. The indication for iron chelation therapy in myelodysplastic syndrome patients is currently controversial. However, cardiovascular magnetic resonance may offer an excellent non-invasive, diagnostic tool for iron overload assessment in myelodysplastic syndromes. Further studies are needed to establish the precise indications of chelation therapy and the clinical implications of this treatment on survival in myelodysplastic syndromes.
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108
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Zhao WH, Zeng QC, Huang BT, Li BS, Chen RL. Decitabine plus thalidomide yields more sustained survival rates than decitabine monotherapy for risk-tailored elderly patients with myelodysplastic syndrome. Leuk Res 2015; 39:424-8. [DOI: 10.1016/j.leukres.2015.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 01/20/2015] [Accepted: 01/25/2015] [Indexed: 10/24/2022]
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109
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Gu Y, Estcourt LJ, Doree C, Trivella M, Hopewell S, Vyas P. Comparison of a restrictive versus liberal red cell transfusion policy for patients with myelodysplasia, aplastic anaemia, and other congenital bone marrow failure disorders. Cochrane Database Syst Rev 2015; 3:CD011577. [PMID: 25983657 PMCID: PMC4430822 DOI: 10.1002/14651858.cd011577] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the efficacy and safety of a restrictive versus liberal red cell transfusion strategy for patients with long-term bone marrow failure. These include myelodysplasia, acquired aplastic anaemia, and other inherited bone marrow failure disorders.
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Affiliation(s)
- Yisu Gu
- Haematology, NHS/ University of Oxford, Oxford, UK
| | - Lise J Estcourt
- Haematology/Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
| | - Carolyn Doree
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | | | - Sally Hopewell
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Paresh Vyas
- MRC Molecular Haematology Unit and Department of Haematology, University of Oxford and Oxford University Hospitals NHS Trust, Oxford, UK
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110
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Hejazi M, Manser AR, Fröbel J, Kündgen A, Zhao X, Schönberg K, Germing U, Haas R, Gattermann N, Uhrberg M. Impaired cytotoxicity associated with defective natural killer cell differentiation in myelodysplastic syndromes. Haematologica 2015; 100:643-52. [PMID: 25682594 DOI: 10.3324/haematol.2014.118679] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 02/09/2015] [Indexed: 12/22/2022] Open
Abstract
Natural killer cells are well known to mediate anti-leukemic responses in myeloid leukemia but their role in myelodysplastic syndromes is not well understood. Here, in a cohort of newly diagnosed patients (n=75), widespread structural and functional natural killer cell defects were identified. One subgroup of patients (13%) had a selective deficiency of peripheral natural killer cells (count <10/mm(3) blood) with normal frequencies of T and natural killer-like T cells. Natural killer cell-deficient patients were predominantly found in high-risk subgroups and deficiency of these cells was significantly associated with poor prognosis. In the second subgroup, comprising the majority of patients (76%), natural killer cells were present but exhibited poor cytotoxicity. The defect was strongly associated with reduced levels of perforin and granzyme B. Notably, natural killer cell function and arming of cytotoxic granules could be fully reconstituted by in vitro stimulation. Further phenotypic analysis of these patients revealed an immature natural killer cell compartment that was biased towards CD56(bright) cells. The residual CD56(dim) cells exhibited a significant increase of the unlicensed NKG2A(-)KIR(-) subset and a striking reduction in complexity of the repertoire of killer cell immunoglobulin-like receptors. Taken together, these results suggest that the widespread defects in natural killer cell function occurring in patients with myelodysplastic syndromes are mostly due to either unsuccessful or inefficient generation of mature, functionally competent natural killer cells, which might contribute to disease progression through impaired immune surveillance.
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Affiliation(s)
- Maryam Hejazi
- Institute for Transplantation Diagnostics and Cell Therapeutics, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Angela R Manser
- Institute for Transplantation Diagnostics and Cell Therapeutics, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Julia Fröbel
- Department of Hematology, Oncology and Clinical Immunology, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Andrea Kündgen
- Department of Hematology, Oncology and Clinical Immunology, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Xiaoyi Zhao
- Institute for Transplantation Diagnostics and Cell Therapeutics, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Kathrin Schönberg
- Institute for Transplantation Diagnostics and Cell Therapeutics, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Rainer Haas
- Department of Hematology, Oncology and Clinical Immunology, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Norbert Gattermann
- Department of Hematology, Oncology and Clinical Immunology, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Markus Uhrberg
- Institute for Transplantation Diagnostics and Cell Therapeutics, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
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111
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Germing U, Kobbe G, Haas R, Gattermann N. Myelodysplastic syndromes: diagnosis, prognosis, and treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 110:783-90. [PMID: 24300826 DOI: 10.3238/arztebl.2013.0783] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 07/23/2013] [Accepted: 07/23/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS) are malignant stem-cell diseases that are usually diagnosed in elderly patients who present with anemia or, less commonly, bi- or pancytopenia. Their incidence in persons over age 80 is above 50 new cases per 100,000 persons per year. Their clinical course is highly variable. About one-quarter of all patients with MDS develop acute leukemia. The median survival time from the moment of diagnosis is about 30 months. METHOD We selectively searched the PubMed database for pertinent articles and guidelines from the years 2000-2013. We used the search term "myelodysplastic syndromes." RESULTS MDS are diagnosed by cytology, with consideration of the degree of dysplasia and the percentage of blast cells in the blood and bone marrow, and on a cytogenetic basis, as recommended in the WHO classification. In particular, chromosomal analysis is necessary for prognostication. The Revised International Prognosis Scoring System (IPSS-R) enables more accurate prediction of the course of disease by dividing patients into a number of low- and high-risk groups. The median survival time ranges from a few months to many years. The approved treatments, aside from transfusion therapy, include iron depletion therapy for low-risk patients, lenalidomide for low-risk patients with a deletion on the long arm of chromosome 5, and 5-azacytidine for high-risk patients. High-risk patients up to age 70 who have no major accompanying illnesses should be offered allogenic stem-cell transplantation with curative intent. The cure rates range from 30% to 50%. Mucositis, hemorrhages, infections, and graft-versus-host diseases are the most common complications of this form of treatment. CONCLUSION Myelodysplastic syndromes are treated on an individualized, risk-adapted basis after precise diagnostic evaluation and after assessment of the prognosis. More studies are needed so that stage-adapted treatment can be improved still further.
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Affiliation(s)
- Ulrich Germing
- Department of Haematology, Oncology and Clinical Immunology, Düsseldorf University Hospital
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112
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Xiong H, Yang XY, Han J, Wang Q, Zou ZL. Cytokine expression patterns and mesenchymal stem cell karyotypes from the bone marrow microenvironment of patients with myelodysplastic syndromes. ACTA ACUST UNITED AC 2015; 48:207-13. [PMID: 25608238 PMCID: PMC4381940 DOI: 10.1590/1414-431x20144051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/02/2014] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to explore cytokine expression patterns and cytogenetic
abnormalities of mesenchymal stem cells (MSCs) from the bone marrow microenvironment
of Chinese patients with myelodysplastic syndromes (MDS). Bone marrow samples were
obtained from 30 cases of MDS (MDS group) and 30 healthy donors (control group). The
expression pattern of cytokines was detected by customized protein array. The
karyotypes of MSCs were analyzed using fluorescence in situ
hybridization. Compared with the control group, leukemia inhibitory factor, stem cell
factor (SCF), stromal cell-derived factor (SDF-1), bone morphogenetic protein 4,
hematopoietic stem cell (HSC) stimulating factor, and transforming growth factor-β in
the MDS group were significantly downregulated (P<0.05), while interferon-γ
(IFN-γ), tumor necrosis factor-α (TNF-α), and programmed death ligand (B7-H1) were
significantly upregulated (P<0.05). For chromosome abnormality analysis, the
detection rate of abnormal karyotypes (+8, -8, -20, 20q-, -Y, -7, 5q-) was 30% in the
MDS group and 0% in the control group. In conclusion, the up- and downregulated
expression of these cytokines might play a key role in the pathogenesis of MDS. Among
them, SCF and SDF-1 may play roles in the apoptosis of HSCs in MDS; and IFN-γ, TNF-α,
and B7-H1 may be associated with apoptosis of bone marrow cells in MDS. In addition,
the abnormal karyotypes might be actively involved in the pathogenesis of MDS.
Further studies are required to determine the role of abnormal karyotypes in the
occurrence and development of MDS.
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Affiliation(s)
- H Xiong
- Department of Hematology, Shanghai Clinical Research Center, Chinese Academy of Sciences, Shanghai Xuhui District Central Hospital, Shanghai, China
| | - X Y Yang
- Department of Hematology, Shanghai Clinical Research Center, Chinese Academy of Sciences, Shanghai Xuhui District Central Hospital, Shanghai, China
| | - J Han
- Department of Hematology, Shanghai Clinical Research Center, Chinese Academy of Sciences, Shanghai Xuhui District Central Hospital, Shanghai, China
| | - Q Wang
- Department of Hematology, Shanghai Clinical Research Center, Chinese Academy of Sciences, Shanghai Xuhui District Central Hospital, Shanghai, China
| | - Z L Zou
- Department of Hematology, Shanghai Clinical Research Center, Chinese Academy of Sciences, Shanghai Xuhui District Central Hospital, Shanghai, China
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113
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Abou Zahr A, Saad Aldin E, Komrokji RS, Zeidan AM. Clinical utility of lenalidomide in the treatment of myelodysplastic syndromes. J Blood Med 2014; 6:1-16. [PMID: 25565910 PMCID: PMC4278786 DOI: 10.2147/jbm.s50482] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Myelodysplastic syndromes (MDS) represent a heterogeneous group of acquired clonal hematopoietic disorders characterized by peripheral blood cytopenias, paradoxical BM hypercellularity, ineffective hematopoiesis, and increased risk of leukemic transformation. Risk stratification, using different prognostic scores and markers, is at the core of MDS management. Deletion 5q [del(5q)] MDS is a distinct class of MDS characterized by the haploinsufficiency of specific genes, microRNAs, and proteins, which has been linked to increased sensitivity to the drug lenalidomide. Phase II and III clinical trials have demonstrated the efficacy of lenalidomide in improving clinical outcomes of patients with del(5q) MDS, including reduction in red blood cell transfusion requirements and improvements in quality of life. Lenalidomide has also demonstrated some activity in non-del(5q) lower-risk MDS as well as higher-risk MDS, especially in combination with other agents. In this paper, we review the pathogenesis of del(5q) MDS, the proposed mechanisms of action of lenalidomide, the major clinical trials that documented the activity of lenalidomide in different MDS populations, potential predictors of benefit from the drug and suggested mechanisms of resistance, and the use of combination strategies to expand the clinical utility of lenalidomide in MDS.
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Affiliation(s)
- Abdallah Abou Zahr
- Section of Hematology/Oncology, Department of Internal Medicine, Mount Sinai Beth Israel, New York City, New York, NY, USA
| | - Ehab Saad Aldin
- Department of Internal Medicine, Medstar Good Samaritan Hospital, Baltimore, MD, USA
| | - Rami S Komrokji
- Department of Malignant Hematology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Amer M Zeidan
- Division of Hematology, Department of Medicine, Yale University, New Haven, CT, USA
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114
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Dinmohamed AG, van Norden Y, Visser O, Posthuma EFM, Huijgens PC, Sonneveld P, van de Loosdrecht AA, Jongen-Lavrencic M. The use of medical claims to assess incidence, diagnostic procedures and initial treatment of myelodysplastic syndromes and chronic myelomonocytic leukemia in the Netherlands. Leuk Res 2014; 39:177-82. [PMID: 25533930 DOI: 10.1016/j.leukres.2014.11.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 11/26/2014] [Accepted: 11/27/2014] [Indexed: 12/14/2022]
Abstract
Myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML) may be underreported in cancer registries such as the Netherlands Cancer Registry (NCR). Analysis of Dutch medical claims can complement NCR data on MDS and CMML. We analyzed data on 3681 MDS patients and 235 CMML patients aged ≥18 years with initial claims for MDS or CMML from the Dutch nationwide medical claims-based Diagnosis Treatment Combination Information System (DIS) between 2008 and 2010. Clinical information was available in the DIS. MDS and CMML were diagnosed without a bone marrow (BM) examination in almost half of the patients. The age-standardized incidence rate (ASR) per 100,000 in the cohort that underwent BM examinations compared with NCR data was 2.8 vs. 3.3 for MDS and 0.2 vs. 0.4 for CMML in 2008-2010. A conservative treatment approach was associated with increasing age and absence of BM examination in MDS (p<0.001 for both) and CMML patients (p<0.033 for both). In conclusion, the ASR of MDS in the cohort that underwent BM examinations was comparable with the NCR. The majority of elderly patients, either with or without BM examinations, received no therapy. Together, MDS and CMML may be misdiagnosed and inappropriately managed without a BM confirmation.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Bone Marrow/pathology
- Female
- Humans
- Incidence
- Insurance Claim Review
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Middle Aged
- Myelodysplastic Syndromes/diagnosis
- Myelodysplastic Syndromes/epidemiology
- Myelodysplastic Syndromes/pathology
- Netherlands
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Affiliation(s)
- Avinash G Dinmohamed
- Department of Hematology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Yvette van Norden
- Clinical Trial Center, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Otto Visser
- Department of Registration and Research, Comprehensive Cancer Centre The Netherlands, Utrecht, The Netherlands
| | | | - Peter C Huijgens
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Arjan A van de Loosdrecht
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mojca Jongen-Lavrencic
- Department of Hematology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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115
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Estcourt LJ. Why has demand for platelet components increased? A review. Transfus Med 2014; 24:260-8. [DOI: 10.1111/tme.12155] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 06/24/2014] [Accepted: 09/06/2014] [Indexed: 01/16/2023]
Affiliation(s)
- L. J. Estcourt
- NHS Blood and Transplant; Oxford UK
- Radcliffe Department of Medicine; University of Oxford; Oxford UK
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116
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Chihara D, Ito H, Katanoda K, Shibata A, Matsuda T, Sobue T, Matsuo K. Incidence of myelodysplastic syndrome in Japan. J Epidemiol 2014; 24:469-73. [PMID: 25088696 PMCID: PMC4213221 DOI: 10.2188/jea.je20140042] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Myelodysplastic syndromes (MDS) are a diverse group of clonal hematopoietic stem cell malignancies that primarily affect the elderly. Although the incidence of MDS in western countries has been well investigated, little is known about the incidence in Asian populations. Methods To identify the incidence of MDS in Japan, we used population-based registry data from 1993 to 2008. The data represented 33.1% of the Japanese population. A total of 7995 patients were reported to the registry with newly diagnosed MDS during the study period. Results Median age at diagnosis was 76 years. Incidence sharply increased with age, particularly in those aged over 70 years. The most recent crude incidence rate of MDS was 3.8 (95% CI 3.6–4.1) cases per 100 000 for men and 2.4 (95% CI 2.2–2.6) cases per 100 000 for women in 2008. Age-adjusted incidences of MDS in 2008, standardized by the world standard population, were 1.6 and 0.8 cases per 100 000 for men and women, respectively, while incidences standardized by the 1985 Japanese population were 2.5 and 1.2 cases per 100 000 for men and women, respectively. Conclusions Our study reveals that some elderly patients suffer from MDS in Japan, but the incidence is lower than in Western countries. In current clinical practice, many elderly MDS patients are treated with supportive therapy based on an incomplete diagnosis, suggesting that the incidence estimated in this study might still be substantially underestimated. Accurate evaluation of the health impact of MDS requires evaluation of the mortality of the disease, continued surveillance, and improvement in the quality of cancer registry data.
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Affiliation(s)
- Dai Chihara
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute
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117
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Fenaux P, Haase D, Sanz GF, Santini V, Buske C. Myelodysplastic syndromes: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25 Suppl 3:iii57-69. [PMID: 25185242 DOI: 10.1093/annonc/mdu180] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- P Fenaux
- Service d'Hématologie Clinique, Groupe Francophone des Myélodysplasies (GFM), Hôpital St Louis (Assistance Publique, Hôpitaux de Paris) and Paris 7 University, Paris, France
| | - D Haase
- Clinics of Hematology and Medical Oncology, University Medicine, Goettingen, Germany
| | - G F Sanz
- Department of Haematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - V Santini
- Functional Unit of Haematology, AOU Careggi, University of Florence, Firenze, Italy
| | - C Buske
- Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, University Hospital, Ulm, Germany
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118
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Bach V, Schruckmayer G, Sam I, Kemmler G, Stauder R. Prevalence and possible causes of anemia in the elderly: a cross-sectional analysis of a large European university hospital cohort. Clin Interv Aging 2014; 9:1187-96. [PMID: 25092968 PMCID: PMC4113572 DOI: 10.2147/cia.s61125] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Anemia in later life is associated with increased morbidity and mortality. The purpose of this study was to evaluate the prevalence and possible causes of anemia in the elderly in a well defined hospital cohort. Methods Participants in this cross-sectional, retrospective analysis included all inpatients and outpatients aged ≥64 years with complete blood counts treated at Innsbruck Medical University Hospital between October 1, 2004 and September 29, 2005 (n=19,758, median age 73 years). Results According to World Health Organization criteria, 21.1% of these patients were anemic, ie, 30.7% and 37.0% at 80+ years and 90+ years, respectively. The prevalence of anemia was significantly correlated with advanced age (r=0.21; P<0.001) and male sex (P<0.001). In anemic patients, renal insufficiency with a glomerular filtration rate <30 mL/min/1.73 m2 (11.3% versus 2.1%), hyperinflammation (62.1% versus 31.4%), absolute (14.4% versus 6.9%) or functional (28.2% versus 11.8%) iron deficiency, and folate deficiency (6.7% versus 3.0%) were observed significantly more often than in nonanemic subjects (P<0.001). The pathogenesis of anemia was multifactorial, with decreased renal function (glomerular filtration rate <60 mL/min/1.73 m2), signs of inflammation, and functional iron deficiency detected in 11.4% of anemic patients. Hemoglobin was significantly correlated with elevated C-reactive protein (r= −0.296; P<0.001) and low transferrin saturation (r=0.313; P<0.001). Mean corpuscular volume correlated only weakly with the various anemia subtypes. Cytopenias and morphologic alterations suggestive of underlying myelodysplastic syndromes were found in a substantial proportion of anemic patients, including thrombocytopenia (5.4%), leukopenia (8.26%), and macrocytic alterations (18.4%). Conclusion Anemia was frequently diagnosed in this series of elderly patients. Partly treatable nutritional deficiencies, such as iron or folate deficiency, were identified as possible causes. A complex and heterogeneous interplay of chronic inflammation, functional iron deficiency, and renal impairment was identified in a large proportion of patients. A hitherto undiagnosed myelodysplastic syndrome can be assumed in a relevant proportion of patients. Morphologic classification based on mean corpuscular volume is inadequate from the standpoint of pathogenesis. New parameters are needed to differentiate the multifactorial pathogenesis of anemia in the elderly.
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Affiliation(s)
- Veronika Bach
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Guenter Schruckmayer
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Ines Sam
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Georg Kemmler
- Department of Biological Psychiatry, Innsbruck Medical University, Innsbruck, Austria
| | - Reinhard Stauder
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
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119
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Breccia M, Molica M, Zacheo I, Alimena G. Azacitidine for myelodysplastic patients aged > 65 years: a review of clinical efficacy. Expert Opin Pharmacother 2014; 15:1621-30. [PMID: 24989987 DOI: 10.1517/14656566.2014.936849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Therapeutic strategies for elderly patients affected by myelodysplastic syndromes (MDS) are scarce and only few patients have an advantage in performing allogeneic bone marrow transplant. AREAS COVERED Primary endpoints for treatment of elderly MDS patients were not curative, but rather allowing to maintain a good quality of life through prolongation of overall survival. In this context, azacitidine showed to improve responses in this subset of patients compared to conventional established regimens, such as intensive or low-dose chemotherapy and best supportive care. Good safety profile of the drug was reported either when it was used inside or outside clinical trials. Improved quality of response was observed when the drug was administered beyond the first response, and it is now usually recommended to continue it at the same dose and schedule in responding patients. EXPERT OPINION Evaluation of baseline prognostic factors and comorbidities may help to identify patients who can benefit from the prolonged administration of the drug. Real life data regarding efficacy and safety of azacitidine in MDS elderly patients are required in order to confirm the results of clinical trials.
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Affiliation(s)
- Massimo Breccia
- Sapienza University, Department of Cellular Biotechnologies and Hematology , Via Benevento 6, 00161, Rome , Italy +3906857951 ; +390644241984 ;
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120
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Abstract
Myelodysplastic syndromes are clonal marrow stem-cell disorders, characterised by ineffective haemopoiesis leading to blood cytopenias, and by progression to acute myeloid leukaemia in a third of patients. 15% of cases occur after chemotherapy or radiotherapy for a previous cancer; the syndromes are most common in elderly people. The pathophysiology involves cytogenetic changes with or without gene mutations and widespread gene hypermethylation at advanced stages. Clinical manifestations result from cytopenias (anaemia, infection, and bleeding). Diagnosis is based on examination of blood and bone marrow showing blood cytopenias and hypercellular marrow with dysplasia, with or without excess of blasts. Prognosis depends largely on the marrow blast percentage, number and extent of cytopenias, and cytogenetic abnormalities. Treatment of patients with lower-risk myelodysplastic syndromes, especially for anaemia, includes growth factors, lenalidomide, and transfusions. Treatment of higher-risk patients is with hypomethylating agents and, whenever possible, allogeneic stem-cell transplantation.
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Affiliation(s)
- Lionel Adès
- Service d'hématologie, Hôpital St Louis (Assistance Publique Hôpitaux de Paris) and Paris 7 University, Paris, France
| | - Raphael Itzykson
- Service d'hématologie, Hôpital St Louis (Assistance Publique Hôpitaux de Paris) and Paris 7 University, Paris, France
| | - Pierre Fenaux
- Service d'hématologie, Hôpital St Louis (Assistance Publique Hôpitaux de Paris) and Paris 7 University, Paris, France.
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121
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McQuilten ZK, Wood EM, Polizzotto MN, Campbell LJ, Wall M, Curtis DJ, Farrugia H, McNeil JJ, Sundararajan V. Underestimation of myelodysplastic syndrome incidence by cancer registries: Results from a population-based data linkage study. Cancer 2014; 120:1686-94. [PMID: 24643720 DOI: 10.1002/cncr.28641] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 10/25/2013] [Accepted: 10/28/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS) appear to be underreported to cancer registries, with important implications for cancer and transfusion support service planning and delivery. Two population-based databases were linked to estimate MDS incidence more accurately. METHODS Data from the statewide Victorian Cancer Registry (VCR) and Victorian Admitted Episode Dataset (VAED, capturing all inpatient admissions), in Australia, were linked. Incidence rates were calculated based on VCR reported cases and using additional MDS cases identified in VAED. Differences between reported and nonreported cases were assessed. A multivariate capture-recapture method was used to estimate missed cases. RESULTS Between 2003 and 2010, 2692 cases were reported to VCR and an additional 1562 cases were identified in VAED. Annual incidence rate for those aged 65 years and older based on VCR was 44 per 100,000 (95% confidence interval [CI] = 43-45 per 100,000) and 68 per 100,000 (95% CI = 67-70 per 100,000) using both data sets. Cases not reported to VCR were more likely to have had previous malignancies recorded in VAED (23% versus 19%, P = .003) and to require red cell transfusion (59% versus 54%, P = .003). Using the multivariate model, an estimated 1292 cases were missed by both data sources: the re-estimate was 5546 (95% CI = 5438-5655) MDS cases, with an annual incidence in those aged 65 or older of 103 per 100,000 (95% CI = 100-106). CONCLUSIONS This study reports a higher incidence of MDS using 2 data sources from a large and well-defined population than reported using cancer registry notifications alone.
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Affiliation(s)
- Zoe K McQuilten
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Research and Development, Australian Red Cross Blood Service, Melbourne, Australia
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122
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Dinmohamed AG, Visser O, van Norden Y, Huijgens PC, Sonneveld P, van de Loosdrecht AA, Jongen-Lavrencic M. Trends in incidence, initial treatment and survival of myelodysplastic syndromes: A population-based study of 5144 patients diagnosed in the Netherlands from 2001 to 2010. Eur J Cancer 2014; 50:1004-12. [DOI: 10.1016/j.ejca.2013.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/28/2013] [Accepted: 12/03/2013] [Indexed: 12/13/2022]
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123
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Sperr WR, Kundi M, Wimazal F, Nösslinger T, Schönmetzler-Makrai A, Stauder R, Krieger O, Neukirchen J, Germing U, Pfeilstöcker M, Valent P. Proposed score for survival of patients with myelodysplastic syndromes. Eur J Clin Invest 2013; 43:1120-8. [PMID: 24102333 DOI: 10.1111/eci.12149] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 08/03/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patient selection for various therapies in myelodysplastic syndromes (MDS) is based on prognostic factors, scoring systems and the individual life expectancy. However, most established risk scores include mainly disease-related parameters and thus focus on leukaemia-transformation rather than survival. PATIENTS AND METHODS To establish a risk score optimized for prediction of survival, we analysed international prognostic scoring system (IPSS)-related and IPSS-independent variables in 400 patients with primary MDS (median age: 71 years; range 18-91) of the Austrian MDS platform. Patients were randomly split into a learning sample (60%) and validation sample (40%). External validation was performed on 93 patients from the Heinrich Heine University (Duesseldorf/Germany). RESULTS By multivariate analysis, IPSS, ferritin, age and comorbidities were found to be independent predictive variables concerning survival. Based on weighing these prognostic parameters against each other, we established a novel survival score employing IPSS, ferritin (< 900 ng/mL = 0; ≥ 900 ng/mL = 1), age (< 70 years = 0; 70-79 years = 1; ≥ 80 years = 1.5) and HCT-CI comorbidity (low/intermediate = 0; high = 0.5). Using this score, four prognostic risk groups could be discriminated in the validation sample, with highly significant differences in life expectancy [median survival: LowS (score 0), not reached; Int-1S (score 0.5-1.0), 3.84 years; Int-2S (score 1.5-2.0): 2.72 years; and HighS (score > 2.0): 0.80 years; P < 0.0001]. CONCLUSIONS Our newly proposed score may be a useful tool for survival prediction in MDS and helpful in patient selection for various therapies in daily practice and clinical trials.
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Affiliation(s)
- Wolfgang R Sperr
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
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Gattermann N, Kündgen A, Kellermann L, Zeffel M, Paessens B, Germing U. The impact of age on the diagnosis and therapy of myelodysplastic syndromes: results from a retrospective multicenter analysis in Germany. Eur J Haematol 2013; 91:473-82. [PMID: 24102637 DOI: 10.1111/ejh.12196] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2013] [Indexed: 11/30/2022]
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.
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Affiliation(s)
- Norbert Gattermann
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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125
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Diagnosis and treatment of primary myelodysplastic syndromes in adults: recommendations from the European LeukemiaNet. Blood 2013; 122:2943-64. [PMID: 23980065 DOI: 10.1182/blood-2013-03-492884] [Citation(s) in RCA: 477] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Within the myelodysplastic syndrome (MDS) work package of the European LeukemiaNet, an Expert Panel was selected according to the framework elements of the National Institutes of Health Consensus Development Program. A systematic review of the literature was performed that included indexed original papers, indexed reviews and educational papers, and abstracts of conference proceedings. Guidelines were developed on the basis of a list of patient- and therapy-oriented questions, and recommendations were formulated and ranked according to the supporting level of evidence. MDSs should be classified according to the 2008 World Health Organization criteria. An accurate risk assessment requires the evaluation of not only disease-related factors but also of those related to extrahematologic comorbidity. The assessment of individual risk enables the identification of fit patients with a poor prognosis who are candidates for up-front intensive treatments, primarily allogeneic stem cell transplantation. A high proportion of MDS patients are not eligible for potentially curative treatment because of advanced age and/or clinically relevant comorbidities and poor performance status. In these patients, the therapeutic intervention is aimed at preventing cytopenia-related morbidity and preserving quality of life. A number of new agents are being developed for which the available evidence is not sufficient to recommend routine use. The inclusion of patients into prospective clinical trials is strongly recommended.
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Otrock ZK, Tiu RV, Maciejewski JP, Sekeres MA. The need for additional genetic markers for myelodysplastic syndrome stratification: what does the future hold for prognostication? Expert Rev Hematol 2013; 6:59-68. [PMID: 23373781 DOI: 10.1586/ehm.12.67] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Myelodysplastic syndromes (MDS) constitute a heterogeneous group of clonal hematopoietic disorders. Metaphase cytogenetics has been the gold standard for genetic testing in MDS, but it detects clonal cytogenetic abnormalities in only 50% of cases. New karyotyping tests include FISH, array-based comparative genomic hybridization and single-nucleotide polymorphism arrays. These techniques have increased the detected genetic abnormalities in MDS, many of which confer prognostic significance to overall and leukemia-free survival. This has eventually increased our understanding of MDS genetics. With the help of new technologies, we anticipate that the existing prognostic scoring systems will incorporate mutational data into their parameters. This review discusses the progress in MDS diagnosis through the use of array-based technologies. The authors also discuss the recently investigated genetic mutations in MDS and revisit the MDS classification and prognostic scoring systems.
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Affiliation(s)
- Zaher K Otrock
- Leukemia Program, Cleveland Clinic Taussig Cancer Institute, OH 44195, USA
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127
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Syed YY, Scott LJ. Lenalidomide: A Review of its Use in Patients with Transfusion-Dependent Anaemia due to Low- or Intermediate-1-Risk Myelodysplastic Syndrome Associated with 5q Chromosome Deletion. Drugs 2013; 73:1183-96. [DOI: 10.1007/s40265-013-0071-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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128
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Osca-Gelis G, Puig-Vives M, Saez M, Gallardo D, Lloveras N, Marcos-Gragera R. Population-based incidence of myeloid malignancies: fifteen years of epidemiological data in the province of Girona, Spain. Haematologica 2013; 98:e95-7. [PMID: 23812933 DOI: 10.3324/haematol.2013.084061] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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129
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What's all the fuss about? facts and figures about bone marrow failure and conditions. Curr Hematol Malig Rep 2013; 7:300-9. [PMID: 22936422 DOI: 10.1007/s11899-012-0134-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The epidemiology of bone marrow failure conditions is not well understood. Although several population-based studies conducted in the last two decades have generated a wealth of information, it is still very challenging to interpret disease incidence and prevalence, particularly due to changes in disease classification, misdiagnosis of patients, frequent underreporting and use of different referent populations to calculate rates. Despite these limitations, the available epidemiologic data have revealed significant ethnic, geographic and clinical differences in disease biology that have implications for prevention and treatment strategies. With advances made in targeted therapies facilitated by identification of molecular biomarkers and increased use of curative bone marrow transplantation approach, the natural history of these disease entities is already changing. The epidemiology of these diseases seems to be the next frontier as knowledge gained about the risk factors and pathobiologic correlates could significantly help in designing patient-specific therapies with improved outcomes.
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Avgerinou C, Alamanos Y, Zikos P, Lampropoulou P, Melachrinou M, Labropoulou V, Tavernarakis I, Aktypi A, Kaiafas P, Raptis C, Kouraklis A, Karakantza M, Symeonidis A. The incidence of myelodysplastic syndromes in Western Greece is increasing. Ann Hematol 2013; 92:877-87. [PMID: 23572136 PMCID: PMC3674340 DOI: 10.1007/s00277-013-1712-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 02/15/2013] [Indexed: 11/26/2022]
Abstract
Descriptive epidemiology of the myelodysplastic syndromes (MDS) is always interesting and may reveal time-dependent and geographical variations, as well as occupational exposure. Epidemiological data in Greece are not available by now. We have collected and analyzed medical records of all patients with a documented diagnosis of MDS, performed by an expert hematologist and/or hematopathologist, in the geographical area of Western Greece, during the 20-year period, defined between 1990 and 2009. We have then calculated and described demographic and clinical features of the diagnosed MDS patient population, and assessed the incidence and prevalence rates of MDS in Western Greece, during the above-mentioned period. A total of 855 patients with newly diagnosed MDS have been identified. Refractory anemia was the most common subtype in both FAB and WHO classification systems and in both genders. Del-5q and RARS were more commonly encountered among females, and the dysplastic subtype of chronic myelomonocytic leukemia among males. Trisomy 8 was the most common single cytogenetic abnormality. The crude mean annual incidence rate of MDS was 6.0 per 100,000 inhabitants aged ≥15 years old (all subtypes according to FAB), and it was 4.8 per 100,000 when CMML and RAEB-T were excluded. Crude incidence rate was higher in rural than in urban areas, but this finding was not confirmed after age standardization. Age-standardized mean annual incidence rate in men was 7.9/100,000 and in women 3.4/100,000. A continuously increasing incidence rate of MDS has been observed throughout the study period.
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Affiliation(s)
- Christina Avgerinou
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, 26504 Rion, Patras, Greece
- Department of Public Health, University of Patras Medical School, 26504 Rion, Patras, Greece
| | - Yannis Alamanos
- Department of Public Health, University of Patras Medical School, 26504 Rion, Patras, Greece
| | - Panagiotis Zikos
- Department of Hematology, “St Andrew” General Hospital of Patras, Tsertidou Str. No 1, Patras, 263.35 Greece
| | - Polyxeni Lampropoulou
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, 26504 Rion, Patras, Greece
| | - Maria Melachrinou
- University of Patras Medical School, Laboratory of Pathology, 26504 Rion, Patras, Greece
| | - Vassiliki Labropoulou
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, 26504 Rion, Patras, Greece
| | - Ioannis Tavernarakis
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, 26504 Rion, Patras, Greece
| | - Anthi Aktypi
- Department of Hematology, “Olympion” Hospital, Patras, Volou and Meilihou Str. Kato Sihaina, Patras, 264.41 Greece
| | | | - Christos Raptis
- Department of Internal Medicine, General Hospital of Messolonghi, Greece, Messolonghi, 302.00 Patras, Greece
| | - Alexandra Kouraklis
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, 26504 Rion, Patras, Greece
| | - Marina Karakantza
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, 26504 Rion, Patras, Greece
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, 26504 Rion, Patras, Greece
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131
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Magalhaes SMM, Heredia FF, Fernandes LCM, Almeida PJP, Sousa JC, Souza GF, Pinheiro RF. Beyond race-related disparities: is myelodysplastic syndrome the same everywhere? Leuk Lymphoma 2013; 54:1564-6. [DOI: 10.3109/10428194.2012.749404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | | | | | - Geane F. Souza
- Postgraduation Program in Clinical Medicine, Federal University of Ceará, Brazil
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132
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Okuyama N, Sperr WR, Kadar K, Bakker S, Szombath G, Handa H, Tamura H, Kondo A, Valent P, Várkonyi J, van de Loosdrecht A, Ogata K. Prognosis of acute myeloid leukemia transformed from myelodysplastic syndromes: a multicenter retrospective study. Leuk Res 2013; 37:862-7. [PMID: 23507195 DOI: 10.1016/j.leukres.2013.02.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 01/15/2013] [Accepted: 02/19/2013] [Indexed: 02/02/2023]
Abstract
Myelodysplastic syndromes (MDS) often transform into acute leukemia (AL-MDS), although its prognostic details have not been examined thoroughly. We retrospectively analyzed the prognosis of 189 AL-MDS patients. Ninety-four patients received best supportive care (BSC), and 94 patients received disease-modifying therapies (DMT) that included chemotherapy (CHT) for 65 patients, allogeneic stem-cell transplantation (allo-SCT) for 21 patients, and other therapies for 8 patients. The median survival time was 142 days. In patients treated with BSC, platelet count alone was an independent prognostic factor. In younger patients treated with DMT (<60 years, N=25), allo-SCT was an independent prognostic factor associated with longer survival. In older patients treated with DMT (≥60 years, N=69), the therapy type did not affect survival, and performance status and MDS-specific comorbidity index were independent prognostic factors.
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Affiliation(s)
- Namiko Okuyama
- Division of Hematology, Department of Medicine, Nippon Medical School, Tokyo, Japan
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133
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Schmitt-Graeff AH, Müller MJ, Fisch P. [Myelodysplastic syndromes. Epidemiology, molecular and morphological characteristics and risk stratification]. DER PATHOLOGE 2013; 34:45-55. [PMID: 23322304 DOI: 10.1007/s00292-012-1707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Myelodysplastic syndromes (MDS) comprise a spectrum of clonal stem cell disorders which are currently defined according to the classification scheme of the revised 2008 WHO classification but which may be further refined in the future. The clinical presentation is often characterized by unexplained isolated or multiple peripheral blood cytopenias resulting in anemia, bleeding events or increased susceptibility to infections. The generally hypercellular, but rarely hypocellular and occasionally fibrotic bone marrow shows dysplastic features in ≥ 10 % of cells of at least one of the hematopoietic lineages. These features and enhanced apoptosis, stem cell senescence and immunologic dysregulation result in ineffective hematopoiesis. Diagnostics in MDS relies on complementary consideration of hematological, morphological and cytogenetic/molecular parameters. Methods include marrow and peripheral blood cytology, cytogenetics, fluorescence in situ hybridization (FISH), trephine bone marrow biopsy examination, immunophenotyping and the evaluation of molecular markers by established and new techniques. Mutations affecting growth factor receptors, cell cycle and apoptosis regulators, intracellular signaling, transcription factors, epigenetic regulation and the splicosome are involved in MDS pathogenesis and progression.
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Affiliation(s)
- A H Schmitt-Graeff
- Institut für Pathologie, Universitätsklinikum Freiburg, Breisacherstr. 115a, 79106, Freiburg, Deutschland.
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134
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Rodger EJ, Morison IM. Myelodysplastic syndrome in New Zealand and Australia. Intern Med J 2012; 42:1235-42. [DOI: 10.1111/j.1445-5994.2011.02619.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 09/14/2011] [Indexed: 11/29/2022]
Affiliation(s)
- E. J. Rodger
- Department of Pathology; University of Otago; Dunedin New Zealand
| | - I. M. Morison
- Department of Pathology; University of Otago; Dunedin New Zealand
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135
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Results from a 1-year, open-label, single arm, multi-center trial evaluating the efficacy and safety of oral Deferasirox in patients diagnosed with low and int-1 risk myelodysplastic syndrome (MDS) and transfusion-dependent iron overload. Ann Hematol 2012; 92:191-8. [DOI: 10.1007/s00277-012-1594-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 10/02/2012] [Indexed: 10/27/2022]
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136
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Osca-Gelis G, Puig-Vives M, Saez M, Gallardo D, Solé F, Marcos-Gragera R. Incidence and survival of chronic myelomonocytic leukemia in Girona (Spain): A population-based study, 1993–2007. Leuk Res 2012; 36:1262-6. [DOI: 10.1016/j.leukres.2012.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 06/04/2012] [Accepted: 06/14/2012] [Indexed: 11/16/2022]
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137
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Detectable clonal mosaicism from birth to old age and its relationship to cancer. Nat Genet 2012; 44:642-50. [PMID: 22561516 PMCID: PMC3366033 DOI: 10.1038/ng.2271] [Citation(s) in RCA: 438] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 04/09/2012] [Indexed: 12/15/2022]
Abstract
Clonal mosaicism for large chromosomal anomalies (duplications, deletions and uniparental disomy) was detected using SNP microarray data from over 50,000 subjects recruited for genome-wide association studies. This detection method requires a relatively high frequency of cells (>5–10%) with the same abnormal karyotype (presumably of clonal origin) in the presence of normal cells. The frequency of detectable clonal mosaicism in peripheral blood is low (<0.5%) from birth until 50 years of age, after which it rises rapidly to 2–3% in the elderly. Many of the mosaic anomalies are characteristic of those found in hematological cancers and identify common deleted regions that pinpoint the locations of genes previously associated with hematological cancers. Although only 3% of subjects with detectable clonal mosaicism had any record of hematological cancer prior to DNA sampling, those without a prior diagnosis have an estimated 10-fold higher risk of a subsequent hematological cancer (95% confidence interval = 6–18).
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138
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The long term risk of myelodysplastic syndromes among anemia patients: a population-based study. Leuk Res 2011; 36:327-30. [PMID: 22142797 DOI: 10.1016/j.leukres.2011.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 11/08/2011] [Accepted: 11/13/2011] [Indexed: 11/20/2022]
Abstract
We have utilized the computerized data of a nationwide health plan to elucidate several epidemiologic aspects and risk factor of myelodysplastic syndromes (MDS) in Israel. The annual incidence rate (IR) of reported MDS was of 3.32 per 100,000. Among anemic patients aged 40+, the risk of reported MDS was 56.7 per 100,000. Only 44% of the reported MDS cases had an indication of bone marrow examination. In a multivariable model, older age, hemoglobin level <9 g/dl, white blood cell count of less than 3500/mm(3), and platelet count of less than 100×10(9)/L were associated with a significantly higher risk of MDS. The mean lag period from the first demonstration of anemia to the final diagnosis of MDS was 3.5 years. Our study results could be helpful for improving the detection of patients with high MDS risk, therapeutic decision-making, and designing interventional trials in the future.
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139
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Diagnostic testing, treatment, cost of care, and survival among registered and non-registered patients with myelodysplastic syndromes. Leuk Res 2011; 35:1453-6. [PMID: 21851978 DOI: 10.1016/j.leukres.2011.07.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 07/20/2011] [Accepted: 07/22/2011] [Indexed: 11/23/2022]
Abstract
Considering current reliance on cancer registry data, we sought to assess the potential for bias in myelodysplastic syndrome (MDS) registration using SEER-Medicare data 2001-2005. Using a validated claims-based algorithm, we identified and compared registered and non-registered MDS patients, and found that median cumulative survival was 18 and 28 months, 74% and 64% used erythropoiesis-stimulating agents (ESAs), and average 6-month health care cost was $24,249 and $21,750, respectively. While most non-registered MDS patients showed resource utilization and survival characteristics consistent with lower-risk MDS, a subset was registered as acute myeloid leukemia (7.6%) and accounted for early mortality.
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