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Mo A, Poynton M, Wood E, Shortt J, Brunskill SJ, Doree C, Sandercock J, Saadah N, Luk E, Stanworth SJ, McQuilten Z. Do anemia treatments improve quality of life and physical function in patients with myelodysplastic syndromes (MDS)? A systematic review. Blood Rev 2023; 61:101114. [PMID: 37479599 DOI: 10.1016/j.blre.2023.101114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023]
Abstract
Anemia is common in Myelodysplastic Syndromes (MDS). Different anemia treatments have been tested in clinical studies, but the full impact on patients' health-related quality of life (HRQoL) and physical function is unknown. The main aim of this review was to assess whether improvements in anemia are associated with changes in HRQoL/physical function. Twenty-six full-text publications were identified, enrolling 2211 patients: nine randomized trials (RCTs), fourteen non-randomized studies of interventions and three cross-sectional studies. Interventions included: growth factors/erythropoiesis-stimulating agents (n = 14), red cell transfusion (n = 9), erythroid maturation agents (n = 1), or a combination (n = 2). Five RCTs reported no changes in HRQoL despite erythroid response to the intervention, raising the question of whether anemia treatment alone can effectively improve HRQoL. Many studies were considered at high risk of bias for assessing HRQoL. There is a pressing need for future clinical trials to better define the nature of the relationship between anemia and HRQoL/functional outcomes.
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Affiliation(s)
- Allison Mo
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia; Department of Haematology, Monash Health, Clayton, Australia; Austin Pathology & Department of Haematology, Heidelberg, Australia
| | - Matthew Poynton
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Erica Wood
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia; Department of Haematology, Monash Health, Clayton, Australia
| | - Jake Shortt
- Department of Haematology, Monash Health, Clayton, Australia; School of Clinical Sciences, Monash University, Australia
| | - Susan J Brunskill
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, United Kingdom
| | - Carolyn Doree
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, United Kingdom
| | - Josie Sandercock
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, United Kingdom
| | - Nicholas Saadah
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia
| | - Edwin Luk
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Melbourne, Australia
| | - Simon J Stanworth
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; NHS Blood and Transplant, John Radcliffe Hospital, Oxford, United Kingdom; Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Zoe McQuilten
- Transfusion Research Unit, School of Public Health & Preventive Medicine, Monash University, Australia; Department of Haematology, Monash Health, Clayton, Australia.
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2
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Aslaner Ak M, Gedük A, Acar İH, Polat MG, Sunu C, Bolaman AZ, Hacıbekiroğlu T, Güvenç B, Ertop Ş. Long-Term Efficacy of Erythropoiesis-Stimulating Agents in Patients with Low-Risk or Intermediate-1-Risk Myelodysplastic Syndrome: Multicenter Real-Life Data. Turk J Haematol 2023; 40:92-100. [PMID: 36799095 PMCID: PMC10240155 DOI: 10.4274/tjh.galenos.2023.2022.0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/15/2023] [Indexed: 02/18/2023] Open
Abstract
Objective This study was undertaken to evaluate the long-term clinical efficacy of epoetin alfa and darbepoetin alfa in patients with myelodysplastic syndrome (MDS) in a real-life setting. Materials and Methods A total of 204 patients with low-risk or intermediate-1-risk MDS who received epoetin alfa or darbepoetin alfa were included. Hemoglobin levels and transfusion needs were recorded before treatment and at 12 months, 24 months, 36 months, and 48 months of treatment. Results At the 36-month (p=0.025) and 48-month (p=0.022) visits, epoetin alfa yielded significantly higher hemoglobin levels compared to darbepoetin alfa. Transfusion needs were also significantly lower with epoetin alfa compared to darbepoetin alfa at 24 months (p=0.012) and in the low-risk group compared to the intermediate-risk group at 24 months (p=0.018), 36 months (p=0.025), and 48 months (p<0.001). Treatment response rates at the 24-month, 36-month, and 48-month visits in the epoetin alfa (43.0%, 33.6%, and 27.1%), darbepoetin alfa (29.9%, 22.7%, and 16.5%), low-risk (39.3%, 30.0%, and 26.0%), and intermediate-risk (29.6%, 24.1%, and 11.1%) groups were lower than those obtained at 12 months, and the values differed significantly for the 36-month and 48-month visits with values ranging from p<0.05 to p<0.001. Conclusion This real-life long-term ESA extension study investigated the clinical efficacy of epoetin alfa and darbepoetin alfa for up to 48 months, revealing that treatment efficacy reached a plateau starting from the 24th month of therapy with a continuing decrease in treatment response rates regardless of treatment type, risk status, or gender. Nonetheless, significantly higher hemoglobin levels and marked improvement in transfusion needs were evident in epoetin-treated patients compared to darbepoetin-treated patients and in the low-risk group compared to the intermediate-risk group.
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Affiliation(s)
- Müzeyyen Aslaner Ak
- Zonguldak Bülent Ecevit University Faculty of Medicine, Department of Hematology, Zonguldak, Türkiye
| | - Ayfer Gedük
- Kocaeli University Faculty of Medicine, Department of Hematology, Kocaeli, Türkiye
| | - İbrahim Halil Acar
- Çukurova University Faculty of Medicine, Department of Hematology, Adana, Türkiye
| | - Merve Gökçen Polat
- Kocaeli University Faculty of Medicine, Department of Hematology, Kocaeli, Türkiye
| | - Cenk Sunu
- Sakarya Training and Research Hospital, Clinic of Hematology, Sakarya, Türkiye
| | - Ali Zahit Bolaman
- Adnan Menderes University Faculty of Medicine, Department of Hematology, Aydın, Türkiye
| | - Tuğba Hacıbekiroğlu
- Sakarya Training and Research Hospital, Clinic of Hematology, Sakarya, Türkiye
| | - Birol Güvenç
- Çukurova University Faculty of Medicine, Department of Hematology, Adana, Türkiye
| | - Şehmus Ertop
- Zonguldak Bülent Ecevit University Faculty of Medicine, Department of Hematology, Zonguldak, Türkiye
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3
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Stempel JM, Xie Z, Bewersdorf JP, Stahl M, Zeidan AM. Evolution of Therapeutic Benefit Measurement Criteria in Myelodysplastic Syndromes/Neoplasms. Cancer J 2023; 29:203-211. [PMID: 37195777 DOI: 10.1097/ppo.0000000000000666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
ABSTRACT Myelodysplastic syndromes/neoplasms (MDS) are heterogeneous, clonal myeloid neoplasms characterized by ineffective hematopoiesis, progressive cytopenias, and an increased risk of progression to acute myeloid leukemia. The diversity in disease severity, morphology, and genetic landscape challenges not only novel drug development but also therapeutic response assessment. The MDS International Working Group (IWG) response criteria were first published in the year 2000 focusing on measures of blast burden reduction and hematologic recovery. Despite revision of the IWG criteria in 2006, correlation between IWG-defined responses and patient-focused outcomes, including long-term benefits, remains limited and has potentially contributed to failures of several phase III clinical trials. Several IWG 2006 criteria also lacked clear definitions leading to problems in practical applications and interobserver and intraobserver consistency of response reporting. Although the 2018 revision addressed lower-risk MDS, the most recent update in 2023 redefined responses for higher-risk MDS and has set out to provide clear definitions to enhance consistency while focusing on clinically meaningful outcomes and patient-centered responses. In this review, we analyze the evolution of the MDS response criteria, limitations, and areas of improvement.
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Affiliation(s)
- Jessica M Stempel
- From the Department of Internal Medicine, Hematology Section, Yale School of Medicine, New Haven, CT
| | - Zhuoer Xie
- Department of Hematology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Jan Philipp Bewersdorf
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maximilian Stahl
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Harvard University, Boston, MA
| | - Amer M Zeidan
- From the Department of Internal Medicine, Hematology Section, Yale School of Medicine, New Haven, CT
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4
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Meunier M, Park S. Lower-risk myelodysplastic syndromes: Current treatment options for anemia. EJHAEM 2022; 3:1091-1099. [PMID: 36467818 PMCID: PMC9713208 DOI: 10.1002/jha2.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/11/2022] [Accepted: 06/16/2022] [Indexed: 06/17/2023]
Abstract
Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal hematological disorders. Treatment options are classified and defined by prognostic risk based on the International Prognostic Scoring System (IPSS) and, more recently, the revised IPSS (IPSS-R). The treatment goal for lower-risk MDS is to correct cytopenias or their consequences, with the goal of maintaining or improving quality of life. Erythropoiesis-stimulating agents (ESAs) play an important role in treating anemia. Individuals with MDS who have a 5q deletion are particularly sensitive to treatment with lenalidomide; however, this comprises the minority of patients with MDS. Luspatercept was recently approved in the United States and the European Union for the treatment of ESA-refractory MDS with ring sideroblasts. Research into new treatment options, especially after ESA failure, is needed. In this review, we will focus on the current therapeutic options for MDS-related anemia.
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Affiliation(s)
- Mathieu Meunier
- Department of HaematologyCHU Grenoble AlpesGrenobleFrance
- Institute for Advanced BioscienceUniversité Grenoble AlpesGrenobleFrance
| | - Sophie Park
- Department of HaematologyCHU Grenoble AlpesGrenobleFrance
- Institute for Advanced BioscienceUniversité Grenoble AlpesGrenobleFrance
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5
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Health-Related Quality of Life Outcomes in Patients with Myelodysplastic Syndromes with Ring Sideroblasts Treated with Luspatercept in the MEDALIST Phase 3 Trial. J Clin Med 2021; 11:jcm11010027. [PMID: 35011768 PMCID: PMC8745777 DOI: 10.3390/jcm11010027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/10/2021] [Accepted: 12/18/2021] [Indexed: 11/20/2022] Open
Abstract
Patients with myelodysplastic syndromes (MDS) often experience chronic anemia and long-term red blood cell transfusion dependence associated with significant burden on clinical and health-related quality of life (HRQoL) outcomes. In the MEDALIST trial (NCT02631070), luspatercept significantly reduced transfusion burden in patients with lower-risk MDS who had ring sideroblasts and were refractory to, intolerant to, or ineligible for prior treatment with erythropoiesis-stimulating agents. We evaluated the effect of luspatercept on HRQoL in patients enrolled in MEDALIST using the EORTC QLQ-C30 and the QOL-E questionnaire. Change in HRQoL was assessed every 6 weeks in patients receiving luspatercept with best supportive care (+ BSC) and placebo + BSC from baseline through week 25. No clinically meaningful within-group changes and between-group differences across all domains of the EORTC QLQ-C30 and QOL-E were observed. On one item of the QOL-E MDS-specific disturbances domain, patients treated with luspatercept reported marked improvements in their daily life owing to the reduced transfusion burden, relative to placebo. Taken together with previous reports of luspatercept + BSC reducing transfusion burden in patients from baseline through week 25 in MEDALIST, these results suggest luspatercept may offer a treatment option for patients that reduces transfusion burden while providing stability in HRQoL.
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6
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McQuilten ZK, Busija L, Seymour JF, Stanworth S, Wood EM, Kenealy M, Weinkove R. Hemoglobin is a key determinant of quality of life before and during azacitidine-based therapy for myelodysplasia and low blast count acute myeloid leukemia. Leuk Lymphoma 2021; 63:676-683. [PMID: 34915809 DOI: 10.1080/10428194.2021.2012664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Myelodysplastic syndromes (MDS) have a major impact on quality of life (QoL). We performed a post hoc analysis of two multicenter trials of azacitidine-based disease-modifying therapy for patients with MDS and low blast count acute myeloid leukemia (AML), to identify factors associated with QoL. 231 patients were included (median age 70 years). At baseline, higher initial hemoglobin, but not neutrophil or platelet count, was associated with better global QoL and physical function (p < 0.001 and p = 0.001, respectively). During therapy, increase in hemoglobin was associated with improvement in QoL and physical function (p = 0.005 and p < 0.001, respectively). Lower initial hemoglobin was associated with higher dyspnea and fatigue scores (p < 0.001 and p = 0.001, respectively), and hemoglobin response was associated with improvement in dyspnea and fatigue (p < 0.001 for each). In patients with MDS and low blast count AML, hemoglobin level was strongly correlated with global QoL, physical functioning, dyspnea and fatigue, both before and during azacitidine-based therapy.
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Affiliation(s)
- Zoe K McQuilten
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Haematology, Monash Health, Melbourne, Australia
| | - Ljoudmila Busija
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - John F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Simon Stanworth
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Clinical Department, NHS Blood and Transplant, Oxford, UK.,Radcliffe Department of Medicine, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Erica M Wood
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Haematology, Monash Health, Melbourne, Australia
| | - Melita Kenealy
- Cabrini Health, Melbourne, Australia.,Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Robert Weinkove
- Wellington Blood & Cancer Centre, Capital & Coast District Health Board, Wellington, New Zealand.,Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand.,Department of Pathology and Molecular Medicine, University of Otago Wellington, Wellington, New Zealand
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7
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Oliva EN, Platzbecker U, Fenaux P, Garcia-Manero G, LeBlanc TW, Patel BJ, Kubasch AS, Sekeres MA. Targeting health-related quality of life in patients with myelodysplastic syndromes - Current knowledge and lessons to be learned. Blood Rev 2021; 50:100851. [PMID: 34088518 DOI: 10.1016/j.blre.2021.100851] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 12/12/2022]
Abstract
Using a range of health-related quality of life (HRQoL) instruments, most - but not all - studies of myelodysplastic syndromes (MDS) have reported that lower hemoglobin levels and red blood cell transfusion dependency are associated with worse HRQoL. In addition, some MDS treatments may significantly improve HRQoL, particularly among those patients who respond to therapy; however, the majority of these studies were underpowered for this secondary endpoint. Furthermore, decreased HRQoL has been associated with worse survival outcomes, and HRQoL scores can be used to refine classical prognostic systems. Despite the subjective nature of HRQoL, the importance and validity of measuring it in trials and clinical practice are increasingly being recognized, but properly validated MDS-specific instruments are required. We describe what is currently known about HRQoL in patients with MDS, and the limitations of measuring HRQoL, and we provide some recommendations to improve the measurement of this outcome in future trials.
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Affiliation(s)
- Esther N Oliva
- Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy.
| | - Uwe Platzbecker
- Department of Hematology, Cellular Therapy and Hemostaseology, Leipzig University Hospital, Leipzig, Germany.
| | - Pierre Fenaux
- Service d'Hématologie Séniors, Hôpital Saint-Louis, Université Paris 7, Paris, France.
| | | | | | | | - Anne Sophie Kubasch
- Department of Hematology, Cellular Therapy and Hemostaseology, Leipzig University Hospital, Leipzig, Germany.
| | - Mikkael A Sekeres
- Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
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8
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Chen X, Li N, Weng J, Du X. Senescent Mesenchymal Stem Cells in Myelodysplastic Syndrome: Functional Alterations, Molecular Mechanisms, and Therapeutic Strategies. Front Cell Dev Biol 2021; 8:617466. [PMID: 33644035 PMCID: PMC7905046 DOI: 10.3389/fcell.2020.617466] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/31/2020] [Indexed: 01/01/2023] Open
Abstract
Myelodysplastic syndrome (MDS) is a group of clonal hematopoietic disorders related to hematopoietic stem and progenitor cell dysfunction. However, therapies that are currently used to target hematopoietic stem cells are not effective. These therapies are able to slow the evolution toward acute myeloid leukemia but cannot eradicate the disease. Mesenchymal stem cells (MSCs) have been identified as one of the main cellular components of the bone marrow microenvironment, which plays an indispensable role in normal hematopoiesis. When functional and regenerative capacities of aging MSCs are diminished, some enter replicative senescence, which promotes inflammation and disease progression. Recent studies that investigated the contribution of bone marrow microenvironment and MSCs to the initiation and progression of the disease have offered new insights into the MDS. This review presents the latest updates on the role of MSCs in the MDS and discusses potential targets for the treatment of MDS.
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Affiliation(s)
- Xiaofang Chen
- Department of Hematology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ningyu Li
- Department of Hematology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,School of Medicine, South China University of Technology, Guangzhou, China
| | - Jianyu Weng
- Department of Hematology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,School of Medicine, South China University of Technology, Guangzhou, China
| | - Xin Du
- Department of Hematology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,School of Medicine, South China University of Technology, Guangzhou, China
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9
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Brownstein CG, Daguenet E, Guyotat D, Millet GY. Chronic fatigue in myelodysplastic syndromes: Looking beyond anemia. Crit Rev Oncol Hematol 2020; 154:103067. [PMID: 32739782 DOI: 10.1016/j.critrevonc.2020.103067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/10/2020] [Accepted: 07/23/2020] [Indexed: 12/11/2022] Open
Abstract
Chronic fatigue is the most common and severe symptom in myelodysplastic syndromes (MDS) and has a strong negative association with health-related quality of life (HRQoL). Despite anemia being the most common objective manifestation of MDS, and the associated link between anemia and fatigue, evidence on treatments which temporarily mitigate anemia is equivocal regarding the effects on fatigue. Furthermore, previous work has found weak associations between anemia and chronic fatigue in MDS. As such, given that improving HRQoL is one of the primary treatment aims in MDS, further work is required to identify other potential contributors to chronic fatigue in these patients. In addition to anemia, MDS is associated with numerous other deviations in physiological homeostasis and has negative psychological consequences with links to chronic fatigue. Accordingly, the present review provides several potential aetiologic agents relevant to chronic fatigue in MDS which can be used to guide future research in this field.
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Affiliation(s)
- Callum G Brownstein
- Univ Lyon, UJM-Saint-Etienne, Inter-University Laboratory of Human Movement Biology, EA 7424, F-42023, Saint-Etienne, France.
| | - Elisabeth Daguenet
- Lucien Neuwirth Cancer Institute, Hematology and Cell Therapy, F-42271 Saint-Priest-en-Jarez, France; Lucien Neuwirth Cancer Institute, Research and Teaching Department, F-42271 Saint-Priest-en-Jarez, France
| | - Denis Guyotat
- Lucien Neuwirth Cancer Institute, Hematology and Cell Therapy, F-42271 Saint-Priest-en-Jarez, France; UMR 5239 Laboratoire de Biologie et Modélisation de la Cellule, Ecole Normale Supérieure, Lyon, France
| | - Guillaume Y Millet
- Univ Lyon, UJM-Saint-Etienne, Inter-University Laboratory of Human Movement Biology, EA 7424, F-42023, Saint-Etienne, France; Institut Universitaire de France (IUF), France
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10
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Germing U, Oliva EN, Hiwase D, Almeida A. Treatment of Anemia in Transfusion-Dependent and Non-Transfusion-Dependent Lower-Risk MDS: Current and Emerging Strategies. Hemasphere 2019; 3:e314. [PMID: 31976486 PMCID: PMC6924547 DOI: 10.1097/hs9.0000000000000314] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/10/2019] [Accepted: 10/21/2019] [Indexed: 12/17/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are a heterogeneous group of bone marrow disorders with a highly diverse clinical course. For lower-risk MDS patients, therapeutic objectives aim to correct chronic anemia and improve/maintain health-related quality of life (HRQoL). However, disease burden is often insufficiently recognized, and although some patients do not respond/lose response to standard treatment, many are treated late. This is the case for non-transfusion-dependent patients with symptomatic anemia, in whom delayed treatment initiation may lead to unnecessary morbidity. Current active treatment options for lower-risk MDS are limited. Standard care for lower-risk 5q deletion [del(5q)] MDS patients with anemia remains supportive, consisting of red blood cell (RBC) transfusions, iron chelation therapy, and treatment with erythropoiesis-stimulating agents (ESAs) in the case of low serum erythropoietin levels. Response rates to ESAs range from 15% to 63%, whereas 56% to 67% of patients with del(5q) MDS achieve RBC transfusion independence with lenalidomide. Treatment options for patients’ refractory to ESAs and/or lenalidomide, however, are limited. Frequent transfusions are associated with profound clinical, HRQoL, and economic consequences for transfusion-dependent patients. This review focuses on the multiple unmet clinical needs that exist in the treatment of anemia associated with lower-risk MDS and the current and future treatment options that may improve disease management and patient outcomes.
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Affiliation(s)
- Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Ester N Oliva
- Department of Hematology, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Devendra Hiwase
- Hematology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Antonio Almeida
- Clinical Hematology, Hospital da Luz Lisboa, Lisbon, Portugal
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11
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Balleari E, Filiberti RA, Salvetti C, Allione B, Angelucci E, Bruzzone M, Calzamiglia T, Cavaliere M, Cavalleri M, Cilloni D, Clavio M, Crisà E, Da Col A, Danise P, Pilo F, Ferrero D, Finelli C, Gioia D, Lemoli RM, Masiera E, Messa E, Miglino M, Musto P, Natalie Oliva E, Poloni A, Salvi F, Sanna A, Scudeletti M, Tassara R, Santini V. Effects of different doses of erythropoietin in patients with myelodysplastic syndromes: A propensity score-matched analysis. Cancer Med 2019; 8:7567-7576. [PMID: 31657156 PMCID: PMC6912022 DOI: 10.1002/cam4.2638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/15/2019] [Accepted: 10/05/2019] [Indexed: 11/29/2022] Open
Abstract
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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Affiliation(s)
- Enrico Balleari
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | | | - Chiara Salvetti
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, University of Turin, Torino, Italy
| | - Bernardino Allione
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, Molinette Hospital, Torino, Italy
| | - Emanuele Angelucci
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Marco Bruzzone
- UO Clinical Epidemiology, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Tullio Calzamiglia
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine-ASL 1, Sanremo (IM), Italy
| | - Marina Cavaliere
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine-ASL 2, Savona, Italy
| | - Maurizio Cavalleri
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine-ASL 4, Sestri Levante (GE), Italy
| | - Daniela Cilloni
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Department of Clinical and Biological Sciences, University of Turin, Torino, Italy
| | - Marino Clavio
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Clinic of Hematology, Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Elena Crisà
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, University of Turin, Torino, Italy
| | - Anna Da Col
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Paolo Danise
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, Nocera Hospital, Nocera Inferiore, Italy
| | - Federica Pilo
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology-P.O. Oncologico Businco AOG. Brotzu, Cagliari, Italy
| | - Dario Ferrero
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, University of Turin, Torino, Italy
| | - Carlo Finelli
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, AOU Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Daniela Gioia
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy
| | - Roberto Massimo Lemoli
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Clinic of Hematology, Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Elisa Masiera
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy
| | - Emanuela Messa
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine, ASLTo4, Carmagnola, Italy
| | - Maurizio Miglino
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Clinic of Hematology, Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Pellegrino Musto
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,Regional Department of Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (Pz), Italy
| | - Esther Natalie Oliva
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, Grande Ospedale Metropolitano "Bianchi Melacrino Morelli", Reggio Calabria, Italy
| | - Antonella Poloni
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, Università Politecnica delle Marche, Ancona, Italy
| | - Flavia Salvi
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, SS. Antonio e Biagio Hospital, Alessandria, Italy
| | - Alessandro Sanna
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,Ematologia, Ospedale di Livorno, Livorno, Italy
| | - Marco Scudeletti
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine-ASL 4, Sestri Levante (GE), Italy
| | - Rodolfo Tassara
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine-ASL 2, Savona, Italy
| | - Valeria Santini
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,MDS Unit, AOU Careggi, University of Florence, Firenze, Italy
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12
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Park S, Greenberg P, Yucel A, Farmer C, O'Neill F, De Oliveira Brandao C, Fenaux P. Clinical effectiveness and safety of erythropoietin-stimulating agents for the treatment of low- and intermediate-1-risk myelodysplastic syndrome: a systematic literature review. Br J Haematol 2018; 184:134-160. [PMID: 30549002 DOI: 10.1111/bjh.15707] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Many patients with lower-risk myelodysplastic syndrome (MDS) experience anaemia, which has negative consequences. Erythropoiesis-stimulating agents (ESAs) and their biosimilars are used to treat anaemia in MDS and, currently, epoetin alfa and darbepoetin alfa are commonly used and recommended by clinical guidelines. To better understand the evidence available on the use of ESAs for anaemia in lower-risk MDS, we conducted a systematic literature review to identify randomized and nonrandomized prospective studies reporting on clinical efficacy/effectiveness, patient-reported quality of life (QoL), and safety. We extended our review to include retrospective studies for darbepoetin alfa specifically and to ascertain the feasibility of completing an indirect network meta-analysis comparing epoetin and darbepoetin alfa. Overall, 53 articles reporting on 35 studies were included. The studies indicated a clinical benefit of ESAs, with benefits observed across key clinical outcomes. ESAs showed consistent improvement in erythroid response rates (ESA-naïve, 45-73%; previous ESA exposure, 25-75%) and duration of response. Comparative studies demonstrated similar progression to acute myeloid leukaemia and several showed improved overall survival and QoL. Limited safety concerns were identified. This analysis confirmed ESA therapy should be the foremost first-line treatment of anaemia in most patients with lower-risk MDS who lack the 5q deletion.
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Affiliation(s)
- Sophie Park
- Clinique Universitaire d'Hématologie Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | | | | | | | | | | | - Pierre Fenaux
- Service d'Hématologie Clinique, Hôpital St. Louis and Paris 7 University, Paris, France
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13
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Management of anemia in low-risk myelodysplastic syndromes treated with erythropoiesis-stimulating agents newer and older agents. Med Oncol 2018; 35:76. [DOI: 10.1007/s12032-018-1135-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/12/2018] [Indexed: 10/17/2022]
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14
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A phase 3 randomized, placebo-controlled study assessing the efficacy and safety of epoetin-α in anemic patients with low-risk MDS. Leukemia 2018; 32:2648-2658. [PMID: 29895954 PMCID: PMC6286328 DOI: 10.1038/s41375-018-0118-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/21/2017] [Accepted: 02/14/2018] [Indexed: 11/24/2022]
Abstract
Erythropoiesis-stimulating agents are first choice for treating anemia in low-risk MDS. This double-blind, placebo-controlled study assessed the efficacy and safety of epoetin-α in IPSS low- or intermediate-1 risk (i.e., low-risk) MDS patients with Hb ≤ 10.0 g/dL, with no or moderate RBC transfusion dependence (≤4 RBC units/8 weeks). Patients were randomized, 2:1, to receive epoetin-α 450 IU/kg/week or placebo for 24 weeks, followed by treatment extension in responders. The primary endpoint was erythroid response (ER) through Week 24. Dose adjustments were driven by weekly Hb-levels and included increases, and dose reductions/discontinuation if Hb > 12 g/dL. An independent Response Review Committee (RRC) blindly reviewed all responses, applying IWG-2006 criteria but also considering dose adjustments, drug interruptions and longer periods of observation. A total of 130 patients were randomized (85 to epoetin-α and 45 to placebo). The ER by IWG-2006 criteria was 31.8% for epoetin-α vs 4.4% for placebo (p < 0.001); after RRC review, the ER was 45.9 vs 4.4% (p < 0.001), respectively. Epoetin-α reduced RBC transfusions and increased the time-to-first-transfusion compared with placebo. Thus, epoetin-α significantly improved anemia outcomes in low-risk MDS. IWG-2006 criteria for ER may require amendments to better apply to clinical studies.
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15
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16
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Chan KLL, Mak WMV, Tam YH, Lee KKH. Factors affecting patient-reported outcomes after red blood cell transfusion in medical patients. Transfusion 2017; 58:158-167. [PMID: 29134668 DOI: 10.1111/trf.14397] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 08/13/2017] [Accepted: 09/15/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Physical variables like mortality or cardiac events were used to evaluate the requirement of red blood cell (RBC) transfusion. However, patient-reported outcomes (PROs) of blood transfusion recipients were seldom assessed. The health-related quality of life (HRQoL) of patients before and after RBC transfusion was compared in this study. STUDY DESIGN AND METHODS The study period was February to June 2016. Standardized generic and anemia symptom-specific HRQoL instruments were administered to patients receiving RBC transfusion in the medical unit of a single center. The primary outcome was the change in HRQoL scores on Days 1 and 7 posttransfusion from baseline values on the day of transfusion (Day 0). Multiple linear regression analysis was performed to study the effect of transfusion strategy and other factors on PRO. RESULTS The analysis included 99 general medical patients. The median (interquartile range) pretransfusion hemoglobin level was 72 (66-78) g/L. Two or more units of RBCs were prescribed to 45 patients (45%) on Day 0. Functional Assessment of Cancer Therapy-Anemia Subscale improved significantly on Days 1 and 7 by effect sizes of 0.41 and 0.38, respectively (p < 0.001). Regression analysis showed that lower baseline HRQoL scores were associated with better PRO on both Day 1 and Day 7 (p < 0.001). Transfusion trigger and number of RBC units transfused did not affect the change in HRQoL. CONCLUSION Worse pretransfusion HRQoL is a predictor of improvement in PRO after blood transfusion. There is no evidence that a restrictive transfusion or single-unit policy jeopardizes PRO.
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Affiliation(s)
- Ka Lok Luke Chan
- Division of Haematology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - Wai Man Vivien Mak
- Division of Haematology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - Yat Hung Tam
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kwok Kuen Harold Lee
- Division of Haematology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Kwai Chung, Hong Kong
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17
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Ikenoue T, Naito H, Kitamura T, Hattori H. Epoetin β pegol (continuous erythropoietin receptor activator, CERA) is another choice for the treatment of anemia in myelodysplastic syndrome: a case report. J Med Case Rep 2017; 11:296. [PMID: 29047386 PMCID: PMC5648440 DOI: 10.1186/s13256-017-1468-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 09/20/2017] [Indexed: 12/26/2022] Open
Abstract
Background In most patients, anemia is present when myelodysplastic syndrome is diagnosed. Although darbepoetin α is the first-choice supportive therapy for low-risk myelodysplastic syndrome, half of all patients develop a loss of response to darbepoetin α within 12 months. However, few reports have described supportive therapy after the loss of response to darbepoetin α. Case presentation We herein present a case involving a 65-year-old Japanese woman with low-risk myelodysplastic syndrome whose erythropoiesis-stimulating agent treatment was switched from darbepoetin α to epoetin β pegol (continuous erythropoietin receptor activator) to treat transfusion-dependent anemia. The frequent transfusions required to treat the anemia resulted in transfusion-associated circulatory overload. The transfusion-dependent anemia was initially treated with darbepoetin α, which negated the requirement for transfusion. However, after 12 months of darbepoetin α therapy, the hemoglobin concentration sharply declined. We switched her therapy from darbepoetin α to continuous erythropoietin receptor activator to avoid transfusion. After initiation of continuous erythropoietin receptor activator therapy, the hemoglobin concentration gradually increased and transfusion was not required. At the time of writing, no progression of the anemia had occurred. Conclusions Although darbepoetin α is the first-choice supportive therapy for low-risk myelodysplastic syndrome, continuous erythropoietin receptor activator might be considered the second-choice therapy.
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Affiliation(s)
- Tatsuyoshi Ikenoue
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan. .,Fujiidera Keijinkai Clinic, 1-2-3 Emisaka, Fujiidera, Osaka, Japan.
| | - Hiroshi Naito
- Fujiidera Keijinkai Clinic, 1-2-3 Emisaka, Fujiidera, Osaka, Japan
| | - Tetsuya Kitamura
- Fujiidera Keijinkai Clinic, 1-2-3 Emisaka, Fujiidera, Osaka, Japan
| | - Hideki Hattori
- Division of Hematology, Yao Municipal Hospital, 1-3-1 Ryugecho, Yao, Osaka, Japan
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18
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Almeida A, Fenaux P, List AF, Raza A, Platzbecker U, Santini V. Recent advances in the treatment of lower-risk non-del(5q) myelodysplastic syndromes (MDS). Leuk Res 2017; 52:50-57. [DOI: 10.1016/j.leukres.2016.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/27/2016] [Accepted: 11/11/2016] [Indexed: 12/12/2022]
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19
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Schuler MK, Hentschel L, Göbel J, Balaian E, Hornemann B, Hoffmann J, Kramer M, Kasten P, Bornhäuser M, Ehninger G, Platzbecker U. Effects of a home-based exercise program on physical capacity and fatigue in patients with low to intermediate risk myelodysplastic syndrome-a pilot study. Leuk Res 2016; 47:128-35. [PMID: 27326698 DOI: 10.1016/j.leukres.2016.05.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/20/2016] [Accepted: 05/26/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Fatigue is a frequent and disabling symptom in myelodysplastic syndromes (MDS). There is evidence for the benefit of exercise on fatigue in haematological malignancies, but clinical trials targeting patients with MDS do not exist. METHODS A prospective, non-randomized feasibility trial was conducted to assess the safety and efficacy of a home-based exercise intervention in patients with MDS. Exercise schedule contained endurance or strength training in daily turns over 12 weeks. Outcome measures included 6-min walking distance (6-MWD), an ergometer check, strength measurement of lower limb, abdomen and back, quality of life and fatigue. RESULTS Twenty-one patients (13 male, 8 female) were included. Median age was 66 years (range 29-87). Fifteen patients (71%) continued the program till week 12 (T1), of whom eleven patients met criteria for program completion. There were no adverse events reported due to the intervention. 6-MWD significantly improved from 580m at T0 to 645m at T1 (p<0.05). Fatigue scores did not significantly change over time (MFI: 12.8 vs. 12.3 vs. 11.9; QLQ-C30 fatigue scale: 48.2 vs. 46.7 vs. 47.4). CONCLUSION These data provide evidence that an unsupervised outpatient exercise program is feasible and can improve physical capacity. Randomized, controlled studies implementing these interventions are warranted.
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Affiliation(s)
- Markus K Schuler
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; University Cancer Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Clinic for Internal Medicine II, HELIOS Hospital Emil von Behring, Walterhöferstraße 11, 14165 Berlin, Germany
| | - Leopold Hentschel
- University Cancer Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Julia Göbel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ekaterina Balaian
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Beate Hornemann
- University Cancer Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Julia Hoffmann
- University Physiotherapy Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Michael Kramer
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Philip Kasten
- Department of Sports Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Practice for Orthopedics and Orthopedic Surgery, Tübingen, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gerhard Ehninger
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; University Cancer Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Uwe Platzbecker
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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20
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The Value of Patient Reported Outcomes and Other Patient-Generated Health Data in Clinical Hematology. Curr Hematol Malig Rep 2016; 10:213-24. [PMID: 26040262 DOI: 10.1007/s11899-015-0261-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
With cures and long-term survival rates increasing in hematologic malignancies, increased focus has been placed on gaining a better understanding of the patient experience from disease and treatment effects. This has been the basis for the utilization of patient reported outcomes (PRO) and other patient-generated health data (PGHD) in efforts to improve long-term health-related quality of life (HRQOL). This review will summarize the impact PROs have had on the evolving standard of care for patients with hematologic malignant conditions and will conclude with a template for the integration of PRO and PGHD to enhance the patient experience, using stem cell transplantation as an example.
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21
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Park S, Fenaux P, Greenberg P, Mehta B, Callaghan F, Kim C, Tomita D, Xu H. Efficacy and safety of darbepoetin alpha in patients with myelodysplastic syndromes: a systematic review and meta-analysis. Br J Haematol 2016; 174:730-47. [PMID: 27214305 PMCID: PMC5089656 DOI: 10.1111/bjh.14116] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/15/2016] [Indexed: 01/22/2023]
Abstract
We conducted a systematic review and meta‐analysis to estimate the efficacy of darbepoetin alpha (DA) for treatment of myelodysplastic syndrome (MDS)‐related anaemia. Eligible studies were prospective, interventional, and reported World Health Organization, French‐American‐British, or International Prognostic Scoring System (IPSS) criteria. Outcomes included erythroid response rate (primary); haemoglobin response; change in haemoglobin, transfusion status, and quality‐of‐life (QoL); and safety. Ten studies (N = 647) were analysed. Erythroid response rate range was 38–72%; median response duration range was 12–51+ months. Patients with erythropoietin (EPO) <100 iu/l had 35% [95% confidence interval (CI): 22–48%; P < 0·001) better response than patients with EPO >100 iu/l. Erythropoesis‐stimulating agent (ESA)‐naïve patients had 17% (95% CI: 3–32%; P = 0·022) greater response rate than those previously treated with ESA. Nonetheless, previously treated patients had response rates of 25–75%. Higher baseline haemoglobin levels, higher dose, transfusion‐independence and low‐risk IPSS status were reported by several studies to be associated with better response. QoL, transfusion rates and haemoglobin levels improved with treatment. Hypertension, thromboembolism and progression to acute myeloid leukaemia were reported in 2%, 1% and 1% of patients, respectively. This meta‐analysis suggests that DA treatment can be useful for improving erythroid response in MDS patients with anaemia, even among patients previously treated with ESA.
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Affiliation(s)
- Sophie Park
- CHU de Grenoble, Clinique Universitaire d'Hématologie, Université Grenoble Alpes, Grenoble, France
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22
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Real-life use of erythropoiesis-stimulating agents in myelodysplastic syndromes: a "Gruppo Romano Mielodisplasie (GROM)" multicenter study. Ann Hematol 2016; 95:1059-65. [PMID: 27091349 DOI: 10.1007/s00277-016-2667-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 04/06/2016] [Indexed: 12/13/2022]
Abstract
The Gruppo Romano Mielodisplasie (GROM) conducted a retrospective study in 543 patients with myelodysplastic syndromes (MDS) to evaluate the safety and efficacy of erythropoiesis-stimulating agents (ESAs) in "real-life" clinical practice. The 40.000-UI/week erythropoietin (EPO)-alpha and 30.000-UI/week EPO-beta starting dose were defined "standard," and 80,000 UI/week EPO-alpha and 60.000 UI/week EPO-beta were defined "high." Response was defined according to International Working Group (IWG) 2006 criteria. At ESA's start, median age was 74.2 years (interquartile range (IR) 67.8-79.5) and median hemoglobin was 8.9 g/dl (IR 8.2-9.6). Median time from diagnosis to ESAs start was 3.8 months (IR 0.8-13.2). ESA starting dose was "standard" in 361 patients (66.5 %) and "high" in 182 patients (33.5 %). Erythroid response was observed in 82/185 (44.3 %) transfusion dependent (TD) patients as compared with 226/329 (68.6 %) transfusion independent (TI) ones (p < 0.001). At multivariate analysis, in TD patients, only endogenous EPO levels <50 mU/l were significant (p = 0.046), whereas in TI patients, high-dose ESAs (p < 0.001), abnormal creatinine levels (0.009), and endogenous EPO levels <50 mU/l (p = 0.014) were predictors of response. Responders showed a higher 5-year overall survival (OS) (57.8 vs. 32.2 %, p < 0.001) and leukemia-free survival (76.0 vs. 49.8 %, p < 0.001). At multivariable analysis for OS, response to ESA, low International Prognostic Scoring System (IPSS), no transfusion need, and female sex showed an independent favorable prognostic role. Our results confirm that treatment with ESAs is effective in a real-life MDS setting, particularly at high dose and in TI patients. Prospective studies are needed to define the optimal starting dose.
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23
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Niscola P, Tendas A, Merola R, Orlandi G, Scaramucci L, de Fabritiis P. Regaining the response to erythropoietin following azacitidine in chronic myelomonocytic leukemia previously evolved from refractory anemia. Blood Res 2015; 50:181-2. [PMID: 26457287 PMCID: PMC4595586 DOI: 10.5045/br.2015.50.3.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 11/01/2014] [Accepted: 07/27/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Pasquale Niscola
- Hematology Unit, S. Eugenio Hospital Rome, Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Tendas
- Hematology Unit, S. Eugenio Hospital Rome, Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Roberta Merola
- Hematology Unit, S. Eugenio Hospital Rome, Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Orlandi
- Hematology Unit, S. Eugenio Hospital Rome, Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Scaramucci
- Hematology Unit, S. Eugenio Hospital Rome, Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo de Fabritiis
- Hematology Unit, S. Eugenio Hospital Rome, Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
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24
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Duchmann M, Fenaux P, Cluzeau T. [Management of myelodysplastic syndromes]. Bull Cancer 2015; 102:946-57. [PMID: 26410692 DOI: 10.1016/j.bulcan.2015.07.007] [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] [Received: 04/07/2015] [Revised: 06/25/2015] [Accepted: 07/10/2015] [Indexed: 12/16/2022]
Abstract
Myelodysplastic syndromes are heterogeneous diseases whose molecular characteristics have only been identified in recent years. Better identification of prognostic factors, larger access to allogeneic stem cell transplantation and the advent of new drugs notably hypomethylating agents (azacitidine, decitabine) and lenalidomide have improved patient outcome.
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Affiliation(s)
| | - Pierre Fenaux
- Université Paris 7, Assistance publique des Hôpitaux de Paris, hôpital Saint-Louis, service d'hématologie séniors, 75010 Paris, France
| | - Thomas Cluzeau
- Assistance publique des Hôpitaux de Paris, hôpital Saint-Louis, service d'hématologie, 75010 Paris, France; Centre méditerranéen de médecine moléculaire, Inserm U1065, 06204 Nice, France.
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25
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Oliva EN, Lauseker M, Aloe Spiriti MA, Poloni A, Cortelezzi A, Palumbo GA, Balleari E, Sanpaolo G, Volpe A, Ricco A, Ronco F, Alati C, D'Errigo MG, Santacaterina I, Kündgen A, Germing U, Latagliata R. Early lenalidomide treatment for low and intermediate-1 International Prognostic Scoring System risk myelodysplastic syndromes with del(5q) before transfusion dependence. Cancer Med 2015; 4:1789-97. [PMID: 26376955 PMCID: PMC5123712 DOI: 10.1002/cam4.523] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 08/09/2015] [Accepted: 08/10/2015] [Indexed: 01/19/2023] Open
Abstract
Lenalidomide is approved for the treatment of transfusion-dependent (TD) del(5q) myelodysplastic syndromes (MDS). However, few data are available in patients with transfusion-independent (TI) del(5q) MDS. In the first, observational, part of this 2-part study, we assessed the impact of transfusion dependence on overall survival (OS) and non-leukemic death in untreated del(5q) MDS patients who were TD (n = 136), TI with hemoglobin (Hb) ≥10 mg/dL (n = 88), or TI with Hb <10 mg/dL (n = 96). In the second, interventional, part we assessed the quality-of-life (QoL) benefits and clinical efficacy of lenalidomide (10 mg/day) in 12 patients with TI del(5q) MDS and Hb <10 mg/dL. In the untreated population, OS was significantly longer in TI than in TD patients (TI [Hb ≥10 g/dL], 108 months; TI [Hb <10 g/dL], 77 months; TD, 44 months). Transfusion dependence also negatively impacted non-leukemic death rates. In the interventional part of the study, baseline Hb levels were found to correlate significantly with physical (R = 0.666, P = 0.035) and fatigue (R = 0.604, P = 0.049) QoL scores. Median physical QoL scores improved significantly after 12 weeks' treatment with lenalidomide (+12.5; P = 0.020). Evaluable TI patients experienced early increases in Hb levels, and all attained an erythroid response. Our findings suggest that TI patients with moderate anemia may benefit from early treatment with lenalidomide.
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Affiliation(s)
- Esther N Oliva
- Hematology Unit, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Michael Lauseker
- Institute for Medical Information Science, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | | | | | - Agostino Cortelezzi
- IRCCS Ca' Granda Foundation, Maggiore General Hospital, University of Milan, Milan, Italy
| | - Giuseppe A Palumbo
- Vittorio Emanuele General Hospital, University of Catania, Catania, Italy
| | | | - Grazia Sanpaolo
- Hematology Division, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | | | - Francesca Ronco
- Hematology Unit, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Caterina Alati
- Hematology Unit, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | | | | | - Andrea Kündgen
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - Roberto Latagliata
- Department of Cellular Biotechnology and Hematology, La Sapienza University, Rome, Italy
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Latagliata R, Alati C, Carmosino I, Montagna C, Romano A, Finsinger P, Vozella F, Volpicelli P, Breccia M, Alimena G, Oliva EN. Erythropoietin treatment in patients with myelodysplastic syndromes and type 2 diabetes. J Diabetes 2015; 7:493-6. [PMID: 25060764 DOI: 10.1111/1753-0407.12203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 06/06/2014] [Accepted: 07/13/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of the present study was to assess the role of a concomitant type 2 diabetes as a potentially negative factor in the management of low-risk myelodysplastic syndrome (MDS) patients treated with high-dose (40,000 UI s.c. 2 times/week) recombinant human erythropoietin (EPO) alpha (rHuEPO alpha). METHODS One hundred and forty patients (M/F 69/71, median age 76, interquartile range [IR] 68-81) were included in the analysis: 27/140 (19.2%) had a concomitant type 2 diabetes. RESULTS No difference was reported between patients with and without diabetes as to the grade of anemia, the EPO endogenous levels and the need for transfusional requirement at baseline. Erythroid response was achieved in 79/140 patients (56.4%): factors associated with response were lower EPO levels (P < 0.0001), higher baseline Hb levels (P < 0.0001) and transfusion independence (P < 0.0001). Diabetes was not predictive of response: 17/27 (62.9%) patients with diabetes were responsive to high-dose EPO compared with 62/113 (54.8%) patients without diabetes (P = 0.446). This was confirmed in multivariate analysis, controlling for the effects of Hb levels, transfusion-dependence and serum EPO levels. No difference was observed in relapse rate, response duration and OS between patients with and without diabetes. CONCLUSIONS Concomitant type 2 diabetes was not a major concern in the management of MDS patients.
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Affiliation(s)
- Roberto Latagliata
- Department of Cellular Biotechnology and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Caterina Alati
- Hematology Unit, Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Ida Carmosino
- Department of Cellular Biotechnology and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Chiara Montagna
- Department of Cellular Biotechnology and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Angela Romano
- Department of Cellular Biotechnology and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Paola Finsinger
- Department of Cellular Biotechnology and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Federico Vozella
- Department of Cellular Biotechnology and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Paola Volpicelli
- Department of Cellular Biotechnology and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Massimo Breccia
- Department of Cellular Biotechnology and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Giuliana Alimena
- Department of Cellular Biotechnology and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Esther Natalie Oliva
- Hematology Unit, Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
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Abstract
Myelodysplastic syndromes (MDS) are a constellation of different diseases sharing anemia in the great majority of cases, and this cytopenia defines these pathologies and their most dramatic clinical manifestations. Anemia in MDS is due to ineffective erythropoiesis, with a high degree of apoptosis of marrow erythroid progenitors. These progenitors show distinctive dysplastic features that consent diagnosis, and are recognizable and differentiated, although not easily, from other morphologic alterations present in other types of anemia. Reaching the diagnosis of MDS in a macrocytic anemia and alleviating the symptoms of anemia are therefore an essential objective of the treating physician. In this work, the signs and symptoms of anemia in MDS, as well as its peculiar pathophysiology, are discussed. Erythopoietic stimulating agents (ESAs) are providing the best treatment for anemic MDS patients, but their use is still not approved by health agencies. While still waiting for this waiver, their clinical use is widespread and their effectivness is well known, as well as the dismal prognosis of patients who do not respond to ESAs and require transfusions. MDS with del5q constitute a unique model of anemia whose complex pathophysiology has been clarified at least partially, defining its link to ribosomal alterations likewise what observed in hereditary anemias like Blackfan Diamond anemia. Lenalidomide is the agent that has shown striking and specific erythropoietic activity in del5q MDS, and the basis of this response is starting to be understood. Several new agents are under evaluation for ESA refractory/relapsed MDS patients, targeting different putative mechanisms of ineffective erythropoiesis, and are here reviewed.
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Affiliation(s)
- Valeria Santini
- Hematology, AOU Careggi, University of Florence, Florence, Italy.
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Self-perception of symptoms of anemia and fatigue before and after blood transfusions in patients with myelodysplastic syndromes. Eur J Oncol Nurs 2014; 19:99-106. [PMID: 25488465 DOI: 10.1016/j.ejon.2014.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 08/06/2014] [Accepted: 10/27/2014] [Indexed: 01/06/2023]
Abstract
PURPOSE Myelodysplastic syndromes (MDS) constitute a heterogeneous group of clonal bone marrow disorders characterized by chronic refractory anemia. Many patients with MDS are dependent on regular blood transfusions. The study aimed to investigate symptoms of anemia and fatigue in patients with MDS immediately before and after blood transfusion and to capture patients' descriptions of their symptoms. METHODS Sixteen transfusion-dependent MDS patients with a median age of 74 years (range 67-91) were included. Data were collected longitudinally using the Functional Assessment of Cancer Therapy Anemia (FACT-An) questionnaire, which measured anemia and fatigue symptoms before and after one blood transfusion (day 0-4 and 7). In addition, each patient was interviewed about his or her symptoms. RESULTS The median total score on FACT-An increased after blood transfusion from 50 to 58 (day 0-7, p = 0.016), indicating decreased symptom burden. A positive correlation was found between increments in the FACT-An score and hemoglobin value (rs 0.66, p = 0.02). One of seven items measuring symptoms of anemia (shortness of breath) and two of 13 symptoms of fatigue (feeling fatigue and weakness) changed significantly for the better from day 0 to day 7. The interviews confirmed the FACT-An results and revealed that patients experienced severe fatigue that negatively affected the maintenance of interpersonal relationships. CONCLUSIONS After blood transfusion, symptoms of anemia and fatigue decreased in patients with MDS. The patients felt their symptoms had a negative impact on social life. Providing psychosocial support may contribute to improve the care of patients with transfusion-dependent MDS.
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Castelli R, Deliliers GL, Colombo R, Moreo G, Gallipoli P, Pantaleo G. Biosimilar epoetin in elderly patients with low-risk myelodysplastic syndromes improves anemia, quality of life, and brain function. Ann Hematol 2014; 93:1523-9. [DOI: 10.1007/s00277-014-2070-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
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30
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Recombinant human erythropoietin in very elderly patients with myelodysplastic syndromes: results from a retrospective study. Ann Hematol 2014; 93:1413-20. [DOI: 10.1007/s00277-014-2053-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 03/05/2014] [Indexed: 10/25/2022]
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31
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Hu XM, Tanaka S, Onda K, Yuan B, Toyoda H, Ma R, Liu F, Hirano T. Arsenic disulfide induced apoptosis and concurrently promoted erythroid differentiation in cytokine-dependent myelodysplastic syndrome-progressed leukemia cell line F-36p with complex karyotype including monosomy 7. Chin J Integr Med 2014; 20:387-93. [PMID: 24610410 DOI: 10.1007/s11655-013-1514-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Acute myeloid leukemia progressed from myelodysplastic syndrome (MDS/AML) is generally incurable with poor prognosis for complex karyotype including monosomy 7 (-7). Qinghuang Powder (, QHP), which includes Qing Dai (Indigo naturalis) and Xiong Huang (realgar) in the formula, is effective in treating MDS or MDS/AML even with the unfavorable karyotype, and its therapeutic efficacy could be enhanced by increasing the Xiong huang content in the formula, while Xiong huang contains > 90% arsenic disulfide (As2S2). F-36p cell line was established from a MDS/AML patient with complex karyotype including -7, and was in cytokine-dependent. The present study was to investigate the effects of As2S2 on F-36p cells. METHODS Cell proliferation was measured by an 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. Cell apoptosis was identified by Annexin V-staining. Cell viability was determined by a propidium iodide (PI) exclusion. Erythroid differentiation was evaluated by the expression of cell surface antigen CD235a (GpA). RESULTS After treatment with As2S2 at concentrations of 0.5 to 16 μmol/L for 72 h, As2S2 inhibited the proliferation of F-36p cells. The 50% inhibitory concentrations (IC50) of As2S2 against the proliferation of F-36p cells was 6 μmol/L. The apoptotic cells significantly increased in a dose-dependent mannar (P<0.05). The cell viabilities were significantly inhibited by As2S2 dose-dependent in a dose-dependent manner (P<0.05). Significant increases of CD235a-positive cells were concurrently observed (P<0.05) also in a dose-dependent manner. CONCLUSIONS As2S2 could inhibit proliferation and viability, induce apoptosis, and concurrently promote erythroid differentiation dose-dependently in F-36p cells. As2S2 can inhibit proliferation and viability, induce apoptosis, and concurrently promote erythroid differentiation in cytokine-dependent MDS-progressed human leukemia cell line F-36p with complex karyotype including -7. The data suggest that QHP and/or As2S2 could be a potential candidate in the treatment of MDS or MDS/AML even with unfavorable cytogenetics.
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Affiliation(s)
- Xiao-mei Hu
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, 192-0392, Japan
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Littlewood TJ, Collins GP. Pharmacotherapy of anemia in cancer patients. Expert Rev Clin Pharmacol 2014; 1:307-17. [DOI: 10.1586/17512433.1.2.307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Littlewood T, Collins G. Epoetin alfa: basic biology and clinical utility in cancer patients. Expert Rev Anticancer Ther 2014; 5:947-56. [PMID: 16336085 DOI: 10.1586/14737140.5.6.947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anemia in cancer patients undergoing treatment is common and can cause debilitating symptoms such as fatigue and reduced exercise tolerance. The introduction of recombinant human erythropoietin represents a potential improvement in the treatment of this condition. Clinical studies in patients with solid tumors and nonmyeloid hematologic malignancies have convincingly shown an improvement in mean hemoglobin concentration, a reduction in transfusion requirement along with an improvement in quality of life scores, although an effect on survival is less clear. In myeloid disorders such as myelodysplasia, response to single-agent recombinant human erythropoietin is disappointing but significant synergism with granulocyte colony stimulating factor has been demonstrated and different dosing regimens may also improve response. Unfortunately, a significant proportion of patients remain refractory to treatment. Efforts have been made to identify treatable causes of erythropoietin refractoriness, such as functional iron deficiency, and concomitant intravenous iron supplementation does appear to improve response rates. The search for pretreatment factors that predict response has been largely disappointing, although a promising model for myelodysplasia has been developed that awaits large-scale evaluation. Recombinant human erythropoietin is well tolerated, although there were concerns in the late 1990s due to a rising incidence of pure red cell aplasia in chronic renal failure patients treated with subcutaneous Eprex (Ortho Biologics) in Europe. Since potentially contributory manufacturing processes have been identified and corrected, the incidence of this complication has been falling.
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Affiliation(s)
- Timothy Littlewood
- Department of Haematology, Level 4, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
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Development and validation of QOL-E© instrument for the assessment of health-related quality of life in myelodysplastic syndromes. Open Med (Wars) 2013. [DOI: 10.2478/s11536-013-0196-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
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Sustained resolution of anemia without any treatment after excessive therapeutic response to human recombinant erythropoietin in three patients with myelodysplastic syndromes. Support Care Cancer 2013; 21:1803-5. [DOI: 10.1007/s00520-013-1818-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
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36
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Greenberg PL, Attar E, Bennett JM, Bloomfield CD, Borate U, De Castro CM, Deeg HJ, Frankfurt O, Gaensler K, Garcia-Manero G, Gore SD, Head D, Komrokji R, Maness LJ, Millenson M, O'Donnell MR, Shami PJ, Stein BL, Stone RM, Thompson JE, Westervelt P, Wheeler B, Shead DA, Naganuma M. Myelodysplastic syndromes: clinical practice guidelines in oncology. J Natl Compr Canc Netw 2013; 11:838-74. [PMID: 23847220 PMCID: PMC4000017 DOI: 10.6004/jnccn.2013.0104] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The myelodysplastic syndromes (MDS) represent a heterogeneous group of clonal hematopoietic disorders characterized by cytopenias, dysplasia in one or more myeloid lineages, and the potential for development of acute myeloid leukemia. These disorders primarily affect older adults. The NCCN Clinical Practice Guidelines in Oncology for MDS provide recommendations on the diagnostic evaluation and classification of MDS, risk evaluation according to established prognostic assessment tools (including the new revised International Prognostic Scoring System), treatment options according to risk categories, and management of related anemia.
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Santini V. Treatment of low-risk myelodysplastic syndrome: hematopoietic growth factors erythropoietins and thrombopoietins. Semin Hematol 2013; 49:295-303. [PMID: 23079059 DOI: 10.1053/j.seminhematol.2012.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The use of erythropoietic growth factors has become standard of care in many countries for lower risk myelodysplastic syndrome (MDS) patients. Throughout a large number of clinical trials, therapy with erythropoietic agents has consistently shown improvement of anemia and reduction of transfusion dependence. There is currently no evidence of safety issues of erythropoietins in MDS, including thrombosis, polycythemia, and progressive disease. Large retrospective comparative analyses have shown no increase in mortality in erythropoietin (EPO)-treated MDS patients. Doses of up to 80,000 IU/wk have successfully been employed and the addition of granulocyte colony-stimulating factor (G-CSF) can benefit previously unresponsive patients. Although several other combination therapies have been tested, apart from G-CSF, none has gained wide clinical acceptance. Thrombopoietic agents can alleviate thrombocytopenia and bleeding symptoms in lower risk MDS patients. However, concerns regarding a higher rate of transformation to acute myeloid leukemia and the fear of increased bone marrow fibrosis during treatment have hampered their clinical development.
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Thomas ML, Crisp N, Campbell K. The importance of quality of life for patients living with myelodysplastic syndromes. Clin J Oncol Nurs 2013; 16 Suppl:47-57. [PMID: 22641284 DOI: 10.1188/12.cjon.s1.47-57] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Myelodysplastic syndromes (MDS) are a group of myeloid stem cell clonal disorders characterized by a wide variation in illness trajectory and potential treatment. The physical, functional, emotional, social, and spiritual well-being of individuals with MDS can be affected by both disease and treatment-related factors. As a result, the quality of life (QOL) in patients with MDS may vary throughout the course of the illness. To date, most research exploring QOL in patients with MDS has been conducted as part of clinical trials evaluating the effectiveness of a therapeutic intervention. Although data from those studies are useful, they do not fully address the issues critical to maintaining or maximizing QOL. Oncology nurses are in a key position to assist patients with MDS to maintain their QOL. Findings from comprehensive QOL assessments will guide nurses in providing relevant interventions and evaluating their outcomes. In this manner, oncology nurses can assist their patients to maximize QOL while living with this challenging illness.
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Kelaidi C, Beyne-Rauzy O, Braun T, Sapena R, Cougoul P, Adès L, Pillard F, Lamberto C, Lambert C, Charniot JC, Guerci A, Choufi B, Stamatoullas A, Slama B, De Renzis B, Ame S, Damaj G, Boyer F, Chaury MP, Legros L, Cheze S, Testu A, Gyan E, Béné MC, Rose C, Dreyfus F, Fenaux P. High response rate and improved exercise capacity and quality of life with a new regimen of darbepoetin alfa with or without filgrastim in lower-risk myelodysplastic syndromes: a phase II study by the GFM. Ann Hematol 2013; 92:621-31. [PMID: 23358617 DOI: 10.1007/s00277-013-1686-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/17/2013] [Indexed: 11/24/2022]
Abstract
Darbepoetin (DAR), with or without granulocyte colony-stimulating factor (G-CSF), has proved effective in treating anemia in patients with lower-risk myelodysplastic syndrome (MDS), but its effects on quality of life (QoL) and exercise functioning are less well established. In this phase II study (no. NCT00443339), lower-risk MDS patients with anemia and endogenous erythropoietin (EPO) level <500 IU/L received DAR 500 μg once every 2 weeks for 12 weeks, with G-CSF added at week 12 in non-responders. Physical performance was assessed with the 6-min walking test and, for fit patients, maximal oxygen consumption (VO2max). QoL was evaluated using SF-36 and FACT-An tests. In 99 patients, erythroid response rate according to IWG 2006 criteria was 48 and 56 % at 12 and 24 weeks, respectively. Addition of G-CSF rescued 22 % of non-responders. In 48 % of the responders, interval between darbepoetin injections could be increased for maintenance treatment. Serum EPO level was the only independent predictive factor of response at 12 weeks, and its most discriminant cutoff value was 100 IU/L. QoL and VO2max showed improvement over time in responders, compared with non-responders. With a median follow-up of 52 months, median response duration was not reached, and 3-year cumulative incidence of acute myeloid leukemia and overall survival (OS) was 14.5 and 70 %, respectively. Baseline transfusion dependence, International Prognostic Score System (IPSS), and Revised IPSS accurately predicted OS from treatment onset. Tolerance of darbepoetin was good. In conclusion, this regimen of darbepoetin every 2 weeks yielded high response rates and prolonged response duration. Objective improvement in exercise testing and in patient-reported QoL confirms the clinical relevance of anemia correction with erythropoiesis-stimulating agents.
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Affiliation(s)
- C Kelaidi
- GFM Service d'Hématogie Clinique, Hôpital Avicenne, Assistance Publique des Hôpitaux de Paris, Université Paris 13, 125 rue de Stalingrad, Bobigny, France
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Health-related quality of life outcomes of lenalidomide in transfusion-dependent patients with Low- or Intermediate-1-risk myelodysplastic syndromes with a chromosome 5q deletion: results from a randomized clinical trial. Leuk Res 2012; 37:259-65. [PMID: 23273538 DOI: 10.1016/j.leukres.2012.11.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 11/16/2012] [Accepted: 11/26/2012] [Indexed: 01/23/2023]
Abstract
We report health-related quality of life (HRQL) outcomes assessed using the Functional Assessment of Cancer Therapy-Anemia (FACT-An) among 167 RBC transfusion-dependent patients with IPSS Low-/Intermediate-1-risk del5q31 MDS treated with lenalidomide versus placebo in a randomized phase 3 clinical trial, MDS-004. Mean baseline to 12 week changes in FACT-An Total scores improved following treatment with lenalidomide 5 and 10mg (+5.7 and +5.7, respectively) versus placebo (-2.8) (both p<0.05). Clinically important changes in HRQL from baseline were observed at weeks 12, 24, 36, and 48 among RBC-TI≥26 week responders in both treatment groups. Lenalidomide treatment may be effective in improving HRQL outcomes.
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Kurtin SE, Demakos EP, Hayden J, Boglione C. Treatment of Myelodysplastic Syndromes. Clin J Oncol Nurs 2012; 16 Suppl:23-35. [DOI: 10.1188/12.cjon.s1.23-35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Crisà E, Foli C, Passera R, Darbesio A, Garvey KB, Boccadoro M, Ferrero D. Long-term follow-up of myelodysplastic syndrome patients with moderate/severe anaemia receiving human recombinant erythropoietin + 13-cis-retinoic acid and dihydroxylated vitamin D3: independent positive impact of erythroid response on survival. Br J Haematol 2012; 158:99-107. [DOI: 10.1111/j.1365-2141.2012.09125.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Accepted: 03/06/2012] [Indexed: 12/14/2022]
Affiliation(s)
- Elena Crisà
- Haematology Division; S. Giovanni Battista Hospital; University of Turin; Turin
| | | | - Roberto Passera
- Nuclear Medicine Service; S. Giovanni Battista Hospital; Turin
| | | | - Kimberly B. Garvey
- Haematology Division; S. Giovanni Battista Hospital; University of Turin; Turin
| | - Mario Boccadoro
- Haematology Division; S. Giovanni Battista Hospital; University of Turin; Turin
| | - Dario Ferrero
- Haematology Division; S. Giovanni Battista Hospital; University of Turin; Turin
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The clinical, quality of life, and economic consequences of chronic anemia and transfusion support in patients with myelodysplastic syndromes. Leuk Res 2012; 36:525-36. [DOI: 10.1016/j.leukres.2012.01.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 12/28/2011] [Accepted: 01/09/2012] [Indexed: 12/17/2022]
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Balleari E, Clavio M, Arboscello E, Bellodi A, Bruzzone A, Del Corso L, Lucchetti MV, Miglino M, Passalia C, Pierri I, Ponassi I, Oneto C, Racchi O, Scudeletti M, Vignolo L, Zoppoli G, Gobbi M, Ghio R. Weekly standard doses of rh-EPO are highly effective for the treatment of anemic patients with low-intermediate 1 risk myelodysplastic syndromes. Leuk Res 2011; 35:1472-6. [DOI: 10.1016/j.leukres.2011.05.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 05/18/2011] [Accepted: 05/20/2011] [Indexed: 10/17/2022]
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Azzarà A, Carulli G, Galimberti S, Baratè C, Fazzi R, Cervetti G, Petrini M. High-dose (40,000 IU twice/week) alpha recombinant human erythropoietin as single agent in low/intermediate risk myelodysplastic syndromes: a retrospective investigation on 133 patients treated in a single institution. Am J Hematol 2011; 86:762-7. [PMID: 21850658 DOI: 10.1002/ajh.22111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We investigated the efficacy of alpha recombinant human erythropoietin (α-rHuEPO) administered as single agent to 133 patients affected by myelodysplastic syndromes referring to our Institution in the last 10 years. WPSS score was "very low" in 67%, "low" in 19%, "intermediate" in 14%. The starting schedule was: 40,000 IU bi-weekly, with reduction or suspension, when necessary, in responsive patients. According to new IWG criteria, response rate (RR) was 75%, 66%, 59% after 8, 16, 24 weeks, respectively. Comparing "very low" and "low/intermediate" risk, RR was 81% vs. 43% (P < 0.001); 70% vs. 45% (P = 0.040); 63% vs. 42% (P = NS) after 8, 16, 24 weeks. RR was significantly influenced by transfusion dependence (P = 0.039) and basal serum EPO level (P < 0.001). Mean Hb value was 94 ± 11 g/l before therapy; 114 ± 19 after 8 weeks (P < 0.001); 116 ± 18 after 16 weeks (P < 0.001); 114 ± 17 after 24 weeks (P < 0.001). Reduction or suspension of therapy significantly affected Hb level after 4 (P < 0.001) and 8 weeks (P < 0.01). Conversely, restart of full dosage significantly enhanced again Hb level after 4 (P < 0.01) and 8 weeks (P < 0.001). 65% patients are alive (mean survival: 74 weeks). Seventy percent are alive in the "very low risk" group and 38% in "low/intermediate risk" group (P < 0.001). Overall mean follow-up was 69 weeks (range, 8-376): it was 80 weeks in responsive patients (max 376) and 38 weeks in patients who progressively became unresponsive (max 168) (P < 0.01). Median response was 36 weeks, with 33% of patients still responding after one year. Treatment was well tolerated.
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Affiliation(s)
- Antonio Azzarà
- Division of Haematology, Department of Oncology, Transplants and Advanced Technologies in Medicine, University of Pisa-AOUP, Pisa, Italy.
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Nilsson-Ehle H, Birgegård G, Samuelsson J, Antunovic P, Astermark J, Garelius H, Engström LM, Kjeldsen L, Nilsson L, Olsson A, Skov-Holm M, Wallvik J, Gulbrandsen N, Hellström-Lindberg E. Quality of life, physical function and MRI T2* in elderly low-risk MDS patients treated to a haemoglobin level of ≥120 g/L with darbepoetin alfa ± filgrastim or erythrocyte transfusions. Eur J Haematol 2011; 87:244-52. [PMID: 21623919 DOI: 10.1111/j.1600-0609.2011.01654.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Anaemia in low-risk myelodysplastic syndromes (MDS) is associated with reduced quality of life (QoL). Response to treatment with erythropoietin ± granulocyte colony-stimulating factor (G-CSF) is associated with improved QoL, but whether transfusion therapy with higher haemoglobin (Hb) target levels has similar effects is unknown. The objective for this prospective phase II Nordic multicentre trial was to assess QoL, response rate and physical function in elderly anaemic MDS patients treated to a target Hb level of >120 g/L. METHODS Thirty-six elderly patients with low- and intermediate-1 risk MDS received darbepoetin (DA) 300 μg/wk, with the addition of G-CSF if no response. If the Hb target was reached at 16 wk, treatment was maintained until week 26. Remaining patients were transfused to reach the target level for at least 8 wk. RESULTS Twenty-seven patients completed the study. Response rate to DA ± G-CSF was 67% in evaluable patients and 56% according to intention to treat. Eighteen patients reached the target Hb level according to protocol. QoL scores for fatigue, dyspnoea, constipation, and physical, role and social functioning improved significantly during study, with similar results for transfused and untransfused patients. Maintaining Hb >120 g/L did not confer a higher transfusion rate, once the target was reached. In two of fourteen patients, magnetic resonance imaging T2* indicated cardiac iron overload, however, without association with ferritin levels. CONCLUSIONS In elderly anaemic MDS patients, an increment in haemoglobin is associated with improved QoL, whether induced by growth factor treatment or transfusion therapy.
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Affiliation(s)
- Herman Nilsson-Ehle
- Section of Hematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Caocci G, La Nasa G, Efficace F. Health-related quality of life and symptom assessment in patients with myelodysplastic syndromes. Expert Rev Hematol 2011; 2:69-80. [PMID: 21082996 DOI: 10.1586/17474086.2.1.69] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Health-related quality of life (HRQOL), symptom burden and other types of patient-reported outcomes have acquired an important role in clinical research, as they can provide precious information on the patient's perspective of disease symptoms and treatment-related effects. HRQOL in patients with myelodysplastic syndromes (MDSs) may be compromised for several reasons, including severe anemia, the frequent occurrence of infections and the need for blood transfusions. Many MDS patients are elderly patients who might present with comorbidities from the time of diagnosis. Our investigation started with a systematic search of the literature in which prospective studies were identified and evaluated according to a predefined coding scheme. Both HRQOL outcomes and traditional clinical reported outcomes were systematically analyzed. Overall, we found nine prospective studies, four of which evaluated HRQOL in a randomized controlled trial setting and, interestingly, all these studies were published after the year 2001, possibly reflecting a recent interest in HRQOL research in MDS patients. While methodological drawbacks were identified, mainly in terms of small sample size and amount of missing data, HROQL assessment has been shown to be feasible in MDS patients and there are excellent examples of how this approach can provide additional key outcomes. A good example is the important evidence emerging from two recent randomized controlled trials that HRQOL benefits are obtained with azacitidine and decitabine compared with supportive care. In view of the enormous potential of patient-reported outcome assessment in providing valuable outcomes in support of clinical decision-making, its implementation in future studies of MDS patients is strongly recommended.
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Affiliation(s)
- Giovanni Caocci
- Cattedra di Ematologia, Centro Trapianti Midollo Osseo, Ospedale R. Binaghi, Via Is Guadazzonis 3, Cagliari, Italy.
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Clinical Use of Erythropoietic Stimulating Agents in Myelodysplastic Syndromes. Oncologist 2011; 16 Suppl 3:35-42. [DOI: 10.1634/theoncologist.2011-s3-35] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Park S, Kelaidi C, Sapena R, Vassilieff D, Beyne-Rauzy O, Coiteux V, Vey N, Ravoet C, Cheze S, Rose C, Legros L, Stamatoullas A, Escoffre-Barbe M, Guerci A, Chaury MP, Fenaux P, Dreyfus F. Early introduction of ESA in low risk MDS patients may delay the need for RBC transfusion: A retrospective analysis on 112 patients. Leuk Res 2010; 34:1430-6. [DOI: 10.1016/j.leukres.2010.05.030] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 05/30/2010] [Accepted: 05/31/2010] [Indexed: 10/19/2022]
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Oliva EN, Nobile F, Alimena G, Specchia G, Danova M, Rovati B, Ronco F, Impera S, Risitano A, Alati C, Breccia M, Carmosino I, Vincelli I, Latagliata R. Darbepoetin alfa for the treatment of anemia associated with myelodysplastic syndromes: efficacy and quality of life. Leuk Lymphoma 2010; 51:1007-14. [PMID: 20367566 DOI: 10.3109/10428191003728610] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To evaluate efficacy, safety, changes in biological features, and quality of life (QoL) in low-risk anemic patients with MDS treated with darbepoetin alfa (DPO), 41 patients received DPO 150 microg weekly for 24 weeks. The dose was increased to 300 microg weekly in non-responsive patients. During treatment, 10/17 (59%) transfusion-dependent (TD) and 13/23 (56%) transfusion-free (TF) patients responded. In TF patients, Hb increased from 9.2 +/- 0.9 g/dL to 10.3 +/- 1.4 g/dL by 24 weeks (p = 0.004). The mean response duration was 22 weeks (95% CI: 19.7-24.0) in TF patients compared with 15.1 weeks (95% CI: 13.3-17.5) in TD patients. Response to treatment was associated with increases in QoL. Decreases in the percentage of apoptotic progenitor cells (p = 0.007) and CD34+ cells (p = 0.005) were observed. These results confirm previous studies demonstrating the safety and efficacy of DPO in anemic patients with MDS. Biological changes and improvement in QoL were associated with response. Adequate dosing is to be determined.
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Affiliation(s)
- Esther N Oliva
- Hematology Unit, Azienda Ospedaliera 'Bianchi-Melacrino-Morelli', Reggio Calabria, Italy.
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