Contributions
Abstract: PB2092
Type: Publication Only
Background
MDS refers to a heterogeneous group of closely related clonal hematopoietic disorders. Among the diagnostic and prognostic tools, pathology, cytogenetics, immunophenotyping and, more recently, point mutations have been shown to identify patients at different risk for survival. Standard treatment options include supportive care, disease-modifying agents and allogeneic hematopoietic stem cell transplantation (HSCT).
Aims
To assess the real-world hematologist practice patterns within Latin-America (LA).
Methods
A printed 23-question survey consisting mainly of multiple-choice questions covering demographics of responders, diagnosis, therapy, evaluation of response, and cause of stopping treatments was collected since August 2015.
Results
Among the 458 respondents: 234 were from Argentine, 8 Bolivia, 47 Chile, 17 Colombia, 16 Dominican Republic, 36 Ecuador, 10 Paraguay, 64 Peru and 26 Uruguay. The response rate was 22-90% depending on their respective Hematology Societies. The majority of responders practiced hematology with a similar distribution within a 5-years range, except for Paraguay (<10: 70%) and Ecuador (>10: 92%). The practice setting was highly heterogeneous: public (0-90%), private/health insurance institution (0-59%) and combined (10-75%). The age-target practice was mostly split between adult and pediatric, however, restricted to adult patients in Paraguay/Uruguay, and mixed in 49% - Peru.
Morphological description is a common practice. Additional tests include the histological examination of the BM (87-100%), being mostly done at the institution of attendance (except for Bolivia/Chile). The cytogenetic analysis (53-100%) and immune-phenotyping by flow cytometry are heterogeneous (42% - 100%), being mostly referred. Physicians from Chile, Colombia, Ecuador and Peru selected to introduce MDS diagnosis as a pre-leukemia, cancer or neoplasia while others avoided these words. The IPSS and IPSS-R are preferred by most hematologists, however, age becomes the main factor for therapeutic decisions. Regarding therapies, most responders indicated transfusions of blood components and erythropoietin +/- other growth factor without differences. Chelation therapy ranged between 0% Bolivia and 100% Colombia/Ecuador. Azacytidine has been highly indicated in 89% Argentine and in 100% Colombia/Ecuador/Dominican Republic. The average for 5-aza-2'-deoxicytidine was lower (77% Colombia followed by 60% Argentine). Lenalidomide was less indicated in 23% Chile and 22% Uruguay. HSCT indication ranged among 33-94% and was not available in Paraguay/Bolivia/Dominican Republic. The access to clinical trials is significantly limited (8-0%). The suspension of treatment was mainly related to lack of response while chelation-therapy to side effects.
Conclusion
This is the first study that explores the real-world clinical practice for MDS in LA showing a heterogeneous access to complementary diagnostic tools, management and treatment in the surveyed countries.
Session topic: 10. Myelodysplastic syndromes – Clinical
Keyword(s): Diagnosis, MDS, Practice
Abstract: PB2092
Type: Publication Only
Background
MDS refers to a heterogeneous group of closely related clonal hematopoietic disorders. Among the diagnostic and prognostic tools, pathology, cytogenetics, immunophenotyping and, more recently, point mutations have been shown to identify patients at different risk for survival. Standard treatment options include supportive care, disease-modifying agents and allogeneic hematopoietic stem cell transplantation (HSCT).
Aims
To assess the real-world hematologist practice patterns within Latin-America (LA).
Methods
A printed 23-question survey consisting mainly of multiple-choice questions covering demographics of responders, diagnosis, therapy, evaluation of response, and cause of stopping treatments was collected since August 2015.
Results
Among the 458 respondents: 234 were from Argentine, 8 Bolivia, 47 Chile, 17 Colombia, 16 Dominican Republic, 36 Ecuador, 10 Paraguay, 64 Peru and 26 Uruguay. The response rate was 22-90% depending on their respective Hematology Societies. The majority of responders practiced hematology with a similar distribution within a 5-years range, except for Paraguay (<10: 70%) and Ecuador (>10: 92%). The practice setting was highly heterogeneous: public (0-90%), private/health insurance institution (0-59%) and combined (10-75%). The age-target practice was mostly split between adult and pediatric, however, restricted to adult patients in Paraguay/Uruguay, and mixed in 49% - Peru.
Morphological description is a common practice. Additional tests include the histological examination of the BM (87-100%), being mostly done at the institution of attendance (except for Bolivia/Chile). The cytogenetic analysis (53-100%) and immune-phenotyping by flow cytometry are heterogeneous (42% - 100%), being mostly referred. Physicians from Chile, Colombia, Ecuador and Peru selected to introduce MDS diagnosis as a pre-leukemia, cancer or neoplasia while others avoided these words. The IPSS and IPSS-R are preferred by most hematologists, however, age becomes the main factor for therapeutic decisions. Regarding therapies, most responders indicated transfusions of blood components and erythropoietin +/- other growth factor without differences. Chelation therapy ranged between 0% Bolivia and 100% Colombia/Ecuador. Azacytidine has been highly indicated in 89% Argentine and in 100% Colombia/Ecuador/Dominican Republic. The average for 5-aza-2'-deoxicytidine was lower (77% Colombia followed by 60% Argentine). Lenalidomide was less indicated in 23% Chile and 22% Uruguay. HSCT indication ranged among 33-94% and was not available in Paraguay/Bolivia/Dominican Republic. The access to clinical trials is significantly limited (8-0%). The suspension of treatment was mainly related to lack of response while chelation-therapy to side effects.
Conclusion
This is the first study that explores the real-world clinical practice for MDS in LA showing a heterogeneous access to complementary diagnostic tools, management and treatment in the surveyed countries.
Session topic: 10. Myelodysplastic syndromes – Clinical
Keyword(s): Diagnosis, MDS, Practice