RBC transfusion independence among lower risk MDS patients receiving hypomethylating agents: a population-level analysis

Leuk Lymphoma. 2019 Dec;60(13):3181-3187. doi: 10.1080/10428194.2019.1622700. Epub 2019 Jun 7.

Abstract

Most patients with lower risk myelodysplastic syndromes (LR-MDS) become red blood cell (RBC) transfusion dependent at some time during their disease course. Hypomethylating agents (HMAs) are frequently used in this setting; however, reported rates of in RBC transfusion independence (TI) achieved with HMA therapy vary significantly between studies. Here we study the real-life clinical effectiveness of HMA in inducing RBC TI in anemic LR-MDS patients using the Surveillance, Epidemiology and End Results (SEER)-Medicare database. We find that approximately 40% of LR-MDS patients who were receiving RBC transfusions and 33% who were dependent on RBC transfusions at HMA initiation ultimately achieved TI. The receipt of ≥3 transfusions in the 8-week period before HMA initiation was significantly associated with lower odds of achieving TI. Our study provides important population level estimates of clinical effectiveness of HMAs in LR-MDS.

Keywords: HMA; MDS; azacitdine; decitabine; transfusion.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antimetabolites, Antineoplastic / pharmacology
  • Antimetabolites, Antineoplastic / therapeutic use*
  • Azacitidine / pharmacology
  • Azacitidine / therapeutic use
  • DNA Methylation / drug effects
  • Decitabine / pharmacology
  • Decitabine / therapeutic use
  • Erythrocyte Transfusion / statistics & numerical data*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Medicare / statistics & numerical data
  • Myelodysplastic Syndromes / blood
  • Myelodysplastic Syndromes / diagnosis
  • Myelodysplastic Syndromes / genetics
  • Myelodysplastic Syndromes / therapy*
  • Retrospective Studies
  • SEER Program / statistics & numerical data
  • Severity of Illness Index
  • Treatment Outcome
  • United States

Substances

  • Antimetabolites, Antineoplastic
  • Decitabine
  • Azacitidine