PROGRESSIVE ANEMIA CAN BE DETECTED MORE THAN 2 YEARS PRIOR TO THE DIAGNOSIS OF MYELODYSPLASTIC SYNDROME: RESULTS FROM THE PRIMARY CARE SETTING IN DENMARK
(Abstract release date: 05/21/15)
EHA Library. Hansen J. 06/13/15; 103126; S506
Disclosure(s): Rigshospitalet, Copenhagen UniversityHematology
Dr. Jakob Werner Hansen
Contributions
Contributions
Abstract
Abstract: S506
Type: Oral Presentation + travel grant
Presentation during EHA20: From 13.06.2015 15:45 to 13.06.2015 16:00
Location: Room C1
Background
Myelodysplastic syndrome (MDS) is a clonal hematopoietic disorder, characterized by inefficient hematopoiesis and peripheral blood cytopenias. Cytopenias are frequently observed in the primary care setting, where the clinical presentation of the patient determines further investigations instituted by the general practitioner (GP). Cytopenias have diverse origins such as inefficient hematopoiesis due to hematological malignancy, but also carcinomatosis, vitamin deficiency, immune dysfunction and viral infections. In primary care, MDS is a rare cause of cytopenias. However, if untreated they are persistent, and important predictors of survival in MDS according to the revised international prognostic scoring system (IPSS-R).
Aims
The aim was to investigate the association between pre-diagnostic cytopenias in primary care patients and the characteristics and prognosis of subsequently occurring MDS with focus on the hemoglobin concentration
Methods
Between 2000 and 2010, GPs in the Copenhagen area were all served by one laboratory, The Elective Laboratory of the Capital Region (ELCR). The Copenhagen Primary Care Differential Count (CopDiff) database based on ELCR data contains information on all complete blood cell counts requested by GPs for 555,039 individuals during this period. Cancer occurrence within the CopDiff population has been obtained by linkage to the Danish Cancer Registry, which is known to have valid and almost complete registration of cancer cases in Denmark. For the present study, we included cases of MDS (ICD-10 = D46) between 2000 and 2010Consecutive hemoglobin counts obtained prior to diagnosis were modeled using linear regression models. An estimate of the time point at which hemoglobin levels fell below the sex specific threshold, was derived from this regression. In this model patients with secondary MDS were excluded, n = 3
Results
We identified 284 patients with MDS of whom 221 had undergone primary care laboratory work-up in the preceding 10 years. The remaining patients (n=63) only had laboratory workup performed after diagnosis and were excluded from the present study. Hence, we included 221 patients with an average of four prediagnostic complete blood counts measured (SD =4,5). Anemia prior to MDS diagnosis was observed for 69% of men and 84% of women (p=0.01). Using the linear regression model, we estimated that male patients in average dropped below the hemoglobin reference range 780 days prior to diagnosis. The corresponding estimate for women was 250 days. At diagnosis women had estimated hemoglobin levels of 5.5 mmol/L (8.8 g/dL) and men of 5.1 mmol/L (8.3 g/dL). The proportion of patients presenting with prediagnostic thrombocytopenia and neutropenia were similar between men and women (table 1)
Summary
Cytopenia is a cardinal finding in MDS. In this study we demonstrate that men on average are anemic two years prior to diagnosis. This is significantly longer than for women. According to the IPSS-R we know that the severity of anemia is a risk factor, and we speculate that this risk factor is an indirect marker of disease duration. If so, it would emphasize the need for earlier diagnosis to improve prognosis, especially in male patients. We are currently performing subgroup analysis according to bone marrow histology, cytogenetics and IPSS-score. This will elucidate if the duration of prediagnostic anemia per se has prognostic impact. Furthermore we will investigate these patterns in subgroups of low- and high-risk MDS and estimate prediagnostic neutro - and thrombocytopenia as well. These data will be presented at the meeting
Keyword(s): Anemia, Epidemiology, Myelodysplasia
Session topic: MDS Clinical
Type: Oral Presentation + travel grant
Presentation during EHA20: From 13.06.2015 15:45 to 13.06.2015 16:00
Location: Room C1
Background
Myelodysplastic syndrome (MDS) is a clonal hematopoietic disorder, characterized by inefficient hematopoiesis and peripheral blood cytopenias. Cytopenias are frequently observed in the primary care setting, where the clinical presentation of the patient determines further investigations instituted by the general practitioner (GP). Cytopenias have diverse origins such as inefficient hematopoiesis due to hematological malignancy, but also carcinomatosis, vitamin deficiency, immune dysfunction and viral infections. In primary care, MDS is a rare cause of cytopenias. However, if untreated they are persistent, and important predictors of survival in MDS according to the revised international prognostic scoring system (IPSS-R).
Aims
The aim was to investigate the association between pre-diagnostic cytopenias in primary care patients and the characteristics and prognosis of subsequently occurring MDS with focus on the hemoglobin concentration
Methods
Between 2000 and 2010, GPs in the Copenhagen area were all served by one laboratory, The Elective Laboratory of the Capital Region (ELCR). The Copenhagen Primary Care Differential Count (CopDiff) database based on ELCR data contains information on all complete blood cell counts requested by GPs for 555,039 individuals during this period. Cancer occurrence within the CopDiff population has been obtained by linkage to the Danish Cancer Registry, which is known to have valid and almost complete registration of cancer cases in Denmark. For the present study, we included cases of MDS (ICD-10 = D46) between 2000 and 2010Consecutive hemoglobin counts obtained prior to diagnosis were modeled using linear regression models. An estimate of the time point at which hemoglobin levels fell below the sex specific threshold, was derived from this regression. In this model patients with secondary MDS were excluded, n = 3
Results
We identified 284 patients with MDS of whom 221 had undergone primary care laboratory work-up in the preceding 10 years. The remaining patients (n=63) only had laboratory workup performed after diagnosis and were excluded from the present study. Hence, we included 221 patients with an average of four prediagnostic complete blood counts measured (SD =4,5). Anemia prior to MDS diagnosis was observed for 69% of men and 84% of women (p=0.01). Using the linear regression model, we estimated that male patients in average dropped below the hemoglobin reference range 780 days prior to diagnosis. The corresponding estimate for women was 250 days. At diagnosis women had estimated hemoglobin levels of 5.5 mmol/L (8.8 g/dL) and men of 5.1 mmol/L (8.3 g/dL). The proportion of patients presenting with prediagnostic thrombocytopenia and neutropenia were similar between men and women (table 1)
Summary
Cytopenia is a cardinal finding in MDS. In this study we demonstrate that men on average are anemic two years prior to diagnosis. This is significantly longer than for women. According to the IPSS-R we know that the severity of anemia is a risk factor, and we speculate that this risk factor is an indirect marker of disease duration. If so, it would emphasize the need for earlier diagnosis to improve prognosis, especially in male patients. We are currently performing subgroup analysis according to bone marrow histology, cytogenetics and IPSS-score. This will elucidate if the duration of prediagnostic anemia per se has prognostic impact. Furthermore we will investigate these patterns in subgroups of low- and high-risk MDS and estimate prediagnostic neutro - and thrombocytopenia as well. These data will be presented at the meeting
Keyword(s): Anemia, Epidemiology, Myelodysplasia
Session topic: MDS Clinical
Abstract: S506
Type: Oral Presentation + travel grant
Presentation during EHA20: From 13.06.2015 15:45 to 13.06.2015 16:00
Location: Room C1
Background
Myelodysplastic syndrome (MDS) is a clonal hematopoietic disorder, characterized by inefficient hematopoiesis and peripheral blood cytopenias. Cytopenias are frequently observed in the primary care setting, where the clinical presentation of the patient determines further investigations instituted by the general practitioner (GP). Cytopenias have diverse origins such as inefficient hematopoiesis due to hematological malignancy, but also carcinomatosis, vitamin deficiency, immune dysfunction and viral infections. In primary care, MDS is a rare cause of cytopenias. However, if untreated they are persistent, and important predictors of survival in MDS according to the revised international prognostic scoring system (IPSS-R).
Aims
The aim was to investigate the association between pre-diagnostic cytopenias in primary care patients and the characteristics and prognosis of subsequently occurring MDS with focus on the hemoglobin concentration
Methods
Between 2000 and 2010, GPs in the Copenhagen area were all served by one laboratory, The Elective Laboratory of the Capital Region (ELCR). The Copenhagen Primary Care Differential Count (CopDiff) database based on ELCR data contains information on all complete blood cell counts requested by GPs for 555,039 individuals during this period. Cancer occurrence within the CopDiff population has been obtained by linkage to the Danish Cancer Registry, which is known to have valid and almost complete registration of cancer cases in Denmark. For the present study, we included cases of MDS (ICD-10 = D46) between 2000 and 2010Consecutive hemoglobin counts obtained prior to diagnosis were modeled using linear regression models. An estimate of the time point at which hemoglobin levels fell below the sex specific threshold, was derived from this regression. In this model patients with secondary MDS were excluded, n = 3
Results
We identified 284 patients with MDS of whom 221 had undergone primary care laboratory work-up in the preceding 10 years. The remaining patients (n=63) only had laboratory workup performed after diagnosis and were excluded from the present study. Hence, we included 221 patients with an average of four prediagnostic complete blood counts measured (SD =4,5). Anemia prior to MDS diagnosis was observed for 69% of men and 84% of women (p=0.01). Using the linear regression model, we estimated that male patients in average dropped below the hemoglobin reference range 780 days prior to diagnosis. The corresponding estimate for women was 250 days. At diagnosis women had estimated hemoglobin levels of 5.5 mmol/L (8.8 g/dL) and men of 5.1 mmol/L (8.3 g/dL). The proportion of patients presenting with prediagnostic thrombocytopenia and neutropenia were similar between men and women (table 1)
Summary
Cytopenia is a cardinal finding in MDS. In this study we demonstrate that men on average are anemic two years prior to diagnosis. This is significantly longer than for women. According to the IPSS-R we know that the severity of anemia is a risk factor, and we speculate that this risk factor is an indirect marker of disease duration. If so, it would emphasize the need for earlier diagnosis to improve prognosis, especially in male patients. We are currently performing subgroup analysis according to bone marrow histology, cytogenetics and IPSS-score. This will elucidate if the duration of prediagnostic anemia per se has prognostic impact. Furthermore we will investigate these patterns in subgroups of low- and high-risk MDS and estimate prediagnostic neutro - and thrombocytopenia as well. These data will be presented at the meeting
Keyword(s): Anemia, Epidemiology, Myelodysplasia
Session topic: MDS Clinical
Type: Oral Presentation + travel grant
Presentation during EHA20: From 13.06.2015 15:45 to 13.06.2015 16:00
Location: Room C1
Background
Myelodysplastic syndrome (MDS) is a clonal hematopoietic disorder, characterized by inefficient hematopoiesis and peripheral blood cytopenias. Cytopenias are frequently observed in the primary care setting, where the clinical presentation of the patient determines further investigations instituted by the general practitioner (GP). Cytopenias have diverse origins such as inefficient hematopoiesis due to hematological malignancy, but also carcinomatosis, vitamin deficiency, immune dysfunction and viral infections. In primary care, MDS is a rare cause of cytopenias. However, if untreated they are persistent, and important predictors of survival in MDS according to the revised international prognostic scoring system (IPSS-R).
Aims
The aim was to investigate the association between pre-diagnostic cytopenias in primary care patients and the characteristics and prognosis of subsequently occurring MDS with focus on the hemoglobin concentration
Methods
Between 2000 and 2010, GPs in the Copenhagen area were all served by one laboratory, The Elective Laboratory of the Capital Region (ELCR). The Copenhagen Primary Care Differential Count (CopDiff) database based on ELCR data contains information on all complete blood cell counts requested by GPs for 555,039 individuals during this period. Cancer occurrence within the CopDiff population has been obtained by linkage to the Danish Cancer Registry, which is known to have valid and almost complete registration of cancer cases in Denmark. For the present study, we included cases of MDS (ICD-10 = D46) between 2000 and 2010Consecutive hemoglobin counts obtained prior to diagnosis were modeled using linear regression models. An estimate of the time point at which hemoglobin levels fell below the sex specific threshold, was derived from this regression. In this model patients with secondary MDS were excluded, n = 3
Results
We identified 284 patients with MDS of whom 221 had undergone primary care laboratory work-up in the preceding 10 years. The remaining patients (n=63) only had laboratory workup performed after diagnosis and were excluded from the present study. Hence, we included 221 patients with an average of four prediagnostic complete blood counts measured (SD =4,5). Anemia prior to MDS diagnosis was observed for 69% of men and 84% of women (p=0.01). Using the linear regression model, we estimated that male patients in average dropped below the hemoglobin reference range 780 days prior to diagnosis. The corresponding estimate for women was 250 days. At diagnosis women had estimated hemoglobin levels of 5.5 mmol/L (8.8 g/dL) and men of 5.1 mmol/L (8.3 g/dL). The proportion of patients presenting with prediagnostic thrombocytopenia and neutropenia were similar between men and women (table 1)
Summary
Cytopenia is a cardinal finding in MDS. In this study we demonstrate that men on average are anemic two years prior to diagnosis. This is significantly longer than for women. According to the IPSS-R we know that the severity of anemia is a risk factor, and we speculate that this risk factor is an indirect marker of disease duration. If so, it would emphasize the need for earlier diagnosis to improve prognosis, especially in male patients. We are currently performing subgroup analysis according to bone marrow histology, cytogenetics and IPSS-score. This will elucidate if the duration of prediagnostic anemia per se has prognostic impact. Furthermore we will investigate these patterns in subgroups of low- and high-risk MDS and estimate prediagnostic neutro - and thrombocytopenia as well. These data will be presented at the meeting
Keyword(s): Anemia, Epidemiology, Myelodysplasia
Session topic: MDS Clinical
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