IMPACT OF ERYTHROPOIETIN STIMULATION AGENTS AND RED BLOOD CELL TRANSFUSION ON HEALTH-RELATED QUALITY OF LIFE IN LOWER-RISK MYELODYSPLASTIC SYNDROME
Author(s): ,
Hege Garelius
Affiliations:
Department of Specialist Medicine,Sahlgrenska university hospital,Göteborg,Sweden
,
Alex Smith
Affiliations:
Epidemiology and Cancer Statistics Group,Department of Health Sciences,York,United Kingdom
,
Simon Appleton
Affiliations:
Epidemiology and Cancer Statistics Group, Department of Health Sciences,University of York,York,United Kingdom
,
David Bowen
Affiliations:
St. James's Institute of Oncology,Leeds Teaching Hospitals,Leeds,United Kingdom
,
Pierre Fenaux
Affiliations:
Service d'Hématologie, Hôpital Saint-Louis,Assistance Publique des Hôpitaux de Paris (AP-HP) and Université Paris 7,Paris,France
,
Argiris Symeonidis
Affiliations:
Dep. of Medicine, Div. Hematology,University of Patras Medical School,Patras,Greece
,
Moshe Mittelman
Affiliations:
Dep. of Medicine A, Tel Aviv Sourasky (Ichilov) Medical Center and Sackler Medical Faculty,Tel Aviv University,Tel Aviv,Israel
,
Reinhard Stauder
Affiliations:
Dep. of Internal Medicine V (Haematology and Oncology) ,Innsbruck Medical University,Innsbruck,Austria
,
Jaroslav Čermák
Affiliations:
Dep. of Clinical Hematology,Inst. of Hematology & Blood Transfusion,Praha,Czech Republic
,
Guillermo Sanz
Affiliations:
Dep. of Haematology,Hospital Universitario y Politécnico La Fe,Valencia,Spain
,
Saskia Langemeijer
Affiliations:
Dep. of Hematology,Radboud University Medical Center,Nijmegen,Netherlands
,
Mette Skov Holm
Affiliations:
Dep. of Haematology,Aarhus University Hospital,Aarhus,Denmark
,
Raphael Itzykson
Affiliations:
Service d'Hématologie,Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris (AP-HP) and Université Paris 7,Paris,France
,
Dominic Culligan
Affiliations:
Dep. of Haematology,Aberdeen Royal Infirmary,Aberdeen,United Kingdom
,
Sonja Heibl
Affiliations:
Dep. of Internal Medicine IV,Klinikum Wels-Grieskirchen,Wels,Austria
,
Juliet Mills
Affiliations:
Dep. of Haematology,Worcestershire Acute Hospitals NHS Trust and University of Birmingham,Birmingham,United Kingdom
,
Teresa Bernal
Affiliations:
Dep. of Hematology and Hemotherapy,University Hospital Central de Asturias,Oviedo,Spain
,
Ioannis Kotsianidis
Affiliations:
Dep. of Hematology,Democritus University of Thrace Medical School, University Hospital of Alexandroupolis,Alexandroupolis,Greece
,
Lionel Ades
Affiliations:
Hôpital Saint-Louis ,Assistance Publique Hôpitaux de Paris,Paris,France
,
Karin Koinig
Affiliations:
Dep. of Internal Medicine V (Hematology and Oncology),Medical University Innsbruck,innsbruck,Austria
,
Corine van Marrewijk
Affiliations:
Dep. of Hematology,Radboud university medical center,Nijmegen,Netherlands
,
Simon Crouch
Affiliations:
Epidemiology and Cancer Statistics Group, Dep. of Health Sciences,University of York,York,United Kingdom
,
Theo de Witte
Affiliations:
Dep. of Tumor Immunology - Nijmegen Center for Molecular Life Sciences,Radboud university medical center,Nijmegen,Netherlands
Eva Hellström-Lindberg
Affiliations:
Dep. of Medicine, Div. Hematology,Karolinska Institutet,Stockholm,Sweden
(Abstract release date: 05/14/20) EHA Library. Garelius H. 06/12/20; 294733; EP816
Dr. Hege Garelius
Dr. Hege Garelius
Contributions
Abstract

Abstract: EP816

Type: e-Poster

Background
 

 

 

 

 

Aims

The objectives of this study were to describe longitudinal changes in health-related quality of life (HRQoL) in lower-risk MDS patients and to compare the time course among subjects who were, neither treated with erythropoietin stimulating agents (ESA) nor red blood cell transfusions (RBCT),  received ESA or RBCT alone, or received both ESA and RBCT. 

Methods

The EUMDS Registry is a prospective, non-interventional longitudinal study initiated in 2008, initially enrolling newly diagnosed patients with IPSS low or intermediate-1 MDS from 16 European countries and Israel. Patient management is recorded electronically every 6 months in a central database, including treatment options, number of transfusions, blood parameters, and patient-reported HRQoL data, using the EQ-5D Index and Visual Analog Scale (VAS). Included patients were enrolled before 01 July 2017 and last censoring of data was September 2019. 

Patients were separated into 4 groups at each clinical visit, depending on the treatment received in the interval preceding their latest visit; Neither ESA nor RBCT, ESA only, RBCT only, and both ESA and RBCT. We analysed the patients longitudinally over time, and according to the ESA and RBCT status during each interval between 2 consecutive visits.

Results

Overall, 2273 patients with lower-risk MDS were included in the study. Figure 1a shows the average EQ-5D measured by visit number over time, stratified by group membership, where membership could be dynamic from visit to visit, as individual patients changed group during the study. Importantly, patients not being treated with ESA or RBCT at any time period had the highest HRQoL. Untransfused patients treated with ESA initially showed increased HRQoL, followed by a stable period and a small decline. Patients continuously receiving RBCT +/- ESA exhibit a gradual decline in QoL over time. Figure 1b shows the change in mean scores, when individual patients transition from group to group, in consecutive visits, averaged for all patients’ visit-to-visit transitions during follow up. 

A second analysis focused on patients with available EQ5D Index and VAS scores, who received ESA but no RBCT at any of the first three visits (n= 718). In this group, there was a clear increase in EQ-5D VAS in the first interval, corresponding to an increase in Hb level. By contrast, patients receiving RBCT with or without ESA, showed no evidence of improving EQ-5D VAS or Hb measurements. 

Conclusion

Lower-risk MDS patients without a need for ESA or transfusions had the best HRQoL. Patients receiving ESA prior to RBCT showed an increase in Hb, EQ-5D, and VAS. Patients receiving RBCT alone showed no improvement in HRQoL. All patients exhibited a decline in HRQoL over time, which was most pronounced in patients receiving RBCT.

These data support starting ESA treatment prior to the initiation of a regular transfusion need. The data also indicate the importance of registering RBCT longitudinally, in order to maintain or improve HRQoL in regularly transfused patients.

Session topic: 10. Myelodysplastic syndromes - Clinical

Keyword(s): Erythropoietin, MDS, Quality of life, Transfusion

Abstract: EP816

Type: e-Poster

Background
 

 

 

 

 

Aims

The objectives of this study were to describe longitudinal changes in health-related quality of life (HRQoL) in lower-risk MDS patients and to compare the time course among subjects who were, neither treated with erythropoietin stimulating agents (ESA) nor red blood cell transfusions (RBCT),  received ESA or RBCT alone, or received both ESA and RBCT. 

Methods

The EUMDS Registry is a prospective, non-interventional longitudinal study initiated in 2008, initially enrolling newly diagnosed patients with IPSS low or intermediate-1 MDS from 16 European countries and Israel. Patient management is recorded electronically every 6 months in a central database, including treatment options, number of transfusions, blood parameters, and patient-reported HRQoL data, using the EQ-5D Index and Visual Analog Scale (VAS). Included patients were enrolled before 01 July 2017 and last censoring of data was September 2019. 

Patients were separated into 4 groups at each clinical visit, depending on the treatment received in the interval preceding their latest visit; Neither ESA nor RBCT, ESA only, RBCT only, and both ESA and RBCT. We analysed the patients longitudinally over time, and according to the ESA and RBCT status during each interval between 2 consecutive visits.

Results

Overall, 2273 patients with lower-risk MDS were included in the study. Figure 1a shows the average EQ-5D measured by visit number over time, stratified by group membership, where membership could be dynamic from visit to visit, as individual patients changed group during the study. Importantly, patients not being treated with ESA or RBCT at any time period had the highest HRQoL. Untransfused patients treated with ESA initially showed increased HRQoL, followed by a stable period and a small decline. Patients continuously receiving RBCT +/- ESA exhibit a gradual decline in QoL over time. Figure 1b shows the change in mean scores, when individual patients transition from group to group, in consecutive visits, averaged for all patients’ visit-to-visit transitions during follow up. 

A second analysis focused on patients with available EQ5D Index and VAS scores, who received ESA but no RBCT at any of the first three visits (n= 718). In this group, there was a clear increase in EQ-5D VAS in the first interval, corresponding to an increase in Hb level. By contrast, patients receiving RBCT with or without ESA, showed no evidence of improving EQ-5D VAS or Hb measurements. 

Conclusion

Lower-risk MDS patients without a need for ESA or transfusions had the best HRQoL. Patients receiving ESA prior to RBCT showed an increase in Hb, EQ-5D, and VAS. Patients receiving RBCT alone showed no improvement in HRQoL. All patients exhibited a decline in HRQoL over time, which was most pronounced in patients receiving RBCT.

These data support starting ESA treatment prior to the initiation of a regular transfusion need. The data also indicate the importance of registering RBCT longitudinally, in order to maintain or improve HRQoL in regularly transfused patients.

Session topic: 10. Myelodysplastic syndromes - Clinical

Keyword(s): Erythropoietin, MDS, Quality of life, Transfusion

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