IS A 1ST LINE ERYTHROPOIETIN APPROACH IN MYELODYSPLASTIC PATIENTS WITH DEL 5Q- USEFUL?
(Abstract release date: 05/19/16)
EHA Library. Volpicelli P. 06/09/16; 134818; PB1918
Dr. Paola Volpicelli
Contributions
Contributions
Abstract
Abstract: PB1918
Type: Publication Only
Background
Efficacy and safety of Erythropoietin (EPO) in patients with myelodysplastic syndromes (MDS) have been demonstrated by various studies, with response rates ≥ 60%. On the other hand, MDS patients with 5q deletion (del5q) and transfusion requirement can achieve high response rates with Lenalidomide, but this drug has shown severe hematologic and extra-hematologic toxicities
Aims
Thus, it could be advisable to evaluate the efficacy of EPO treatment as 1st therapeutic choice in this subset of patients
Methods
To address this issue, 65 consecutive patients with MDS and del5q- [M/F 18/47, median age at onset 72.9 yrs, interquartile range (IR) 65.2 – 81.1] who received EPO treatment at our Institution from 6/2000 to 7/2015 were retrospectively evaluated
Results
According to WHO 2008, 30 patients (46.2%) were classified as del5q-syndrome, 1 (1.5%) as refractory anemia, 20 (30.8%) as refractory citopenia with multilineage dysplasia, 9 (13.8%) as refractory anemia with excess of blasts-1 and 3 (4.6%) as refractory anemia with excess of blasts-2: according to IPSS risk assessment, 30 patients (46.2%) were low-risk, 23 (35.4%) intermediate-1, 9 (13.8%) intermediate-2 and 3 (4.6%) high-risk. As to karyotype, 42 patients (64.6%) had an isolate del5q-, while in the remaining 23 patients (35.4%) there were other co-existing cytogenetic abnormalities. Median age at EPO start was 73.3 yrs (IR 65.9 - 81.7), with a median interval from diagnosis of 6.2 months (IR 1.5 – 14.3). Median Hb level at baseline was 9.0 g/dl (IR 8.2 – 9.5) and 25 patients (38.5%) were transfusion dependent. Median EPO level at baseline was 120 mU/ml (IR 68.8 – 270). Thirty-one patients (47.7%) received standard dose EPO (30,000 - 40,000 UI weekly) and 34 (52.3%) high-dose (60,000 - 80,000 UI weekly). On the whole, 22/65 patients (33.8%) [5/25 (20%) with transfusional requirement and 17/40 (42.5%) without transfusional requirement at baseline] achieved an erythroid response according to IWG 2006 criteria, after a median EPO treatment period of 1.9 months (IR 1.0 – 2.7): among these 22 responding patients, 14 (63.6%) lost the response after a median response period of 14.6 months (IR 7.6 – 29.6), while 8 patients (36.4%) are still in response continuing EPO treatment. In the remaining 43 non responding patients, EPO treatment was discontinued after a median period of 4.0 months (IR 2.0 – 5.9) due to resistance. The median overall survival of the entire cohort from EPO initiation was 47.5 months (95% CI 33.7 – 61.2), without differences between responding and non responding patients (p=0.1)
Conclusion
This retrospective evaluation showed a substantial reduced efficacy of EPO treatment in patients with del5q- compared to other MDS low-risk subgroups, thus supporting the choice of lenalidomide as 1st line approach in such subset of MDS, particularly in patients with del5q- and transfusional requirement
Session topic: E-poster
Keyword(s): Cytogenetic abnormalities, Erythropoietin, Myelodysplasia
Type: Publication Only
Background
Efficacy and safety of Erythropoietin (EPO) in patients with myelodysplastic syndromes (MDS) have been demonstrated by various studies, with response rates ≥ 60%. On the other hand, MDS patients with 5q deletion (del5q) and transfusion requirement can achieve high response rates with Lenalidomide, but this drug has shown severe hematologic and extra-hematologic toxicities
Aims
Thus, it could be advisable to evaluate the efficacy of EPO treatment as 1st therapeutic choice in this subset of patients
Methods
To address this issue, 65 consecutive patients with MDS and del5q- [M/F 18/47, median age at onset 72.9 yrs, interquartile range (IR) 65.2 – 81.1] who received EPO treatment at our Institution from 6/2000 to 7/2015 were retrospectively evaluated
Results
According to WHO 2008, 30 patients (46.2%) were classified as del5q-syndrome, 1 (1.5%) as refractory anemia, 20 (30.8%) as refractory citopenia with multilineage dysplasia, 9 (13.8%) as refractory anemia with excess of blasts-1 and 3 (4.6%) as refractory anemia with excess of blasts-2: according to IPSS risk assessment, 30 patients (46.2%) were low-risk, 23 (35.4%) intermediate-1, 9 (13.8%) intermediate-2 and 3 (4.6%) high-risk. As to karyotype, 42 patients (64.6%) had an isolate del5q-, while in the remaining 23 patients (35.4%) there were other co-existing cytogenetic abnormalities. Median age at EPO start was 73.3 yrs (IR 65.9 - 81.7), with a median interval from diagnosis of 6.2 months (IR 1.5 – 14.3). Median Hb level at baseline was 9.0 g/dl (IR 8.2 – 9.5) and 25 patients (38.5%) were transfusion dependent. Median EPO level at baseline was 120 mU/ml (IR 68.8 – 270). Thirty-one patients (47.7%) received standard dose EPO (30,000 - 40,000 UI weekly) and 34 (52.3%) high-dose (60,000 - 80,000 UI weekly). On the whole, 22/65 patients (33.8%) [5/25 (20%) with transfusional requirement and 17/40 (42.5%) without transfusional requirement at baseline] achieved an erythroid response according to IWG 2006 criteria, after a median EPO treatment period of 1.9 months (IR 1.0 – 2.7): among these 22 responding patients, 14 (63.6%) lost the response after a median response period of 14.6 months (IR 7.6 – 29.6), while 8 patients (36.4%) are still in response continuing EPO treatment. In the remaining 43 non responding patients, EPO treatment was discontinued after a median period of 4.0 months (IR 2.0 – 5.9) due to resistance. The median overall survival of the entire cohort from EPO initiation was 47.5 months (95% CI 33.7 – 61.2), without differences between responding and non responding patients (p=0.1)
Conclusion
This retrospective evaluation showed a substantial reduced efficacy of EPO treatment in patients with del5q- compared to other MDS low-risk subgroups, thus supporting the choice of lenalidomide as 1st line approach in such subset of MDS, particularly in patients with del5q- and transfusional requirement
Session topic: E-poster
Keyword(s): Cytogenetic abnormalities, Erythropoietin, Myelodysplasia
Abstract: PB1918
Type: Publication Only
Background
Efficacy and safety of Erythropoietin (EPO) in patients with myelodysplastic syndromes (MDS) have been demonstrated by various studies, with response rates ≥ 60%. On the other hand, MDS patients with 5q deletion (del5q) and transfusion requirement can achieve high response rates with Lenalidomide, but this drug has shown severe hematologic and extra-hematologic toxicities
Aims
Thus, it could be advisable to evaluate the efficacy of EPO treatment as 1st therapeutic choice in this subset of patients
Methods
To address this issue, 65 consecutive patients with MDS and del5q- [M/F 18/47, median age at onset 72.9 yrs, interquartile range (IR) 65.2 – 81.1] who received EPO treatment at our Institution from 6/2000 to 7/2015 were retrospectively evaluated
Results
According to WHO 2008, 30 patients (46.2%) were classified as del5q-syndrome, 1 (1.5%) as refractory anemia, 20 (30.8%) as refractory citopenia with multilineage dysplasia, 9 (13.8%) as refractory anemia with excess of blasts-1 and 3 (4.6%) as refractory anemia with excess of blasts-2: according to IPSS risk assessment, 30 patients (46.2%) were low-risk, 23 (35.4%) intermediate-1, 9 (13.8%) intermediate-2 and 3 (4.6%) high-risk. As to karyotype, 42 patients (64.6%) had an isolate del5q-, while in the remaining 23 patients (35.4%) there were other co-existing cytogenetic abnormalities. Median age at EPO start was 73.3 yrs (IR 65.9 - 81.7), with a median interval from diagnosis of 6.2 months (IR 1.5 – 14.3). Median Hb level at baseline was 9.0 g/dl (IR 8.2 – 9.5) and 25 patients (38.5%) were transfusion dependent. Median EPO level at baseline was 120 mU/ml (IR 68.8 – 270). Thirty-one patients (47.7%) received standard dose EPO (30,000 - 40,000 UI weekly) and 34 (52.3%) high-dose (60,000 - 80,000 UI weekly). On the whole, 22/65 patients (33.8%) [5/25 (20%) with transfusional requirement and 17/40 (42.5%) without transfusional requirement at baseline] achieved an erythroid response according to IWG 2006 criteria, after a median EPO treatment period of 1.9 months (IR 1.0 – 2.7): among these 22 responding patients, 14 (63.6%) lost the response after a median response period of 14.6 months (IR 7.6 – 29.6), while 8 patients (36.4%) are still in response continuing EPO treatment. In the remaining 43 non responding patients, EPO treatment was discontinued after a median period of 4.0 months (IR 2.0 – 5.9) due to resistance. The median overall survival of the entire cohort from EPO initiation was 47.5 months (95% CI 33.7 – 61.2), without differences between responding and non responding patients (p=0.1)
Conclusion
This retrospective evaluation showed a substantial reduced efficacy of EPO treatment in patients with del5q- compared to other MDS low-risk subgroups, thus supporting the choice of lenalidomide as 1st line approach in such subset of MDS, particularly in patients with del5q- and transfusional requirement
Session topic: E-poster
Keyword(s): Cytogenetic abnormalities, Erythropoietin, Myelodysplasia
Type: Publication Only
Background
Efficacy and safety of Erythropoietin (EPO) in patients with myelodysplastic syndromes (MDS) have been demonstrated by various studies, with response rates ≥ 60%. On the other hand, MDS patients with 5q deletion (del5q) and transfusion requirement can achieve high response rates with Lenalidomide, but this drug has shown severe hematologic and extra-hematologic toxicities
Aims
Thus, it could be advisable to evaluate the efficacy of EPO treatment as 1st therapeutic choice in this subset of patients
Methods
To address this issue, 65 consecutive patients with MDS and del5q- [M/F 18/47, median age at onset 72.9 yrs, interquartile range (IR) 65.2 – 81.1] who received EPO treatment at our Institution from 6/2000 to 7/2015 were retrospectively evaluated
Results
According to WHO 2008, 30 patients (46.2%) were classified as del5q-syndrome, 1 (1.5%) as refractory anemia, 20 (30.8%) as refractory citopenia with multilineage dysplasia, 9 (13.8%) as refractory anemia with excess of blasts-1 and 3 (4.6%) as refractory anemia with excess of blasts-2: according to IPSS risk assessment, 30 patients (46.2%) were low-risk, 23 (35.4%) intermediate-1, 9 (13.8%) intermediate-2 and 3 (4.6%) high-risk. As to karyotype, 42 patients (64.6%) had an isolate del5q-, while in the remaining 23 patients (35.4%) there were other co-existing cytogenetic abnormalities. Median age at EPO start was 73.3 yrs (IR 65.9 - 81.7), with a median interval from diagnosis of 6.2 months (IR 1.5 – 14.3). Median Hb level at baseline was 9.0 g/dl (IR 8.2 – 9.5) and 25 patients (38.5%) were transfusion dependent. Median EPO level at baseline was 120 mU/ml (IR 68.8 – 270). Thirty-one patients (47.7%) received standard dose EPO (30,000 - 40,000 UI weekly) and 34 (52.3%) high-dose (60,000 - 80,000 UI weekly). On the whole, 22/65 patients (33.8%) [5/25 (20%) with transfusional requirement and 17/40 (42.5%) without transfusional requirement at baseline] achieved an erythroid response according to IWG 2006 criteria, after a median EPO treatment period of 1.9 months (IR 1.0 – 2.7): among these 22 responding patients, 14 (63.6%) lost the response after a median response period of 14.6 months (IR 7.6 – 29.6), while 8 patients (36.4%) are still in response continuing EPO treatment. In the remaining 43 non responding patients, EPO treatment was discontinued after a median period of 4.0 months (IR 2.0 – 5.9) due to resistance. The median overall survival of the entire cohort from EPO initiation was 47.5 months (95% CI 33.7 – 61.2), without differences between responding and non responding patients (p=0.1)
Conclusion
This retrospective evaluation showed a substantial reduced efficacy of EPO treatment in patients with del5q- compared to other MDS low-risk subgroups, thus supporting the choice of lenalidomide as 1st line approach in such subset of MDS, particularly in patients with del5q- and transfusional requirement
Session topic: E-poster
Keyword(s): Cytogenetic abnormalities, Erythropoietin, Myelodysplasia
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