Daily practice management of myelodysplastic syndromes in France: data from 907 patients in a one-week cross-sectional study by the Groupe Francophone des Myelodysplasies

Abstract

Background: There is little published information on the everyday clinical management of myelodysplastic syndromes in real world practice.

Design and methods: We conducted a cross-sectional study of all patients with myelodysplastic syndromes attending 74 French centers in a 1-week period for inpatient admission, day-hospital care or outpatient visits.

Results: Nine hundred and seven patients were included; 67.3% had lower-risk myelodysplastic syndromes (International Prognostic Scoring System: low or intermediate-1). Karyotype had been analyzed in 82.5% of the cases and was more often of intermediate or poor risk in patients under 65 years old compared with those who were older. Red blood cell transfusions accounted for as many as 31.4% of the admissions. Endogenous erythropoietin level was less than 500 IU/L in 88% of the patients tested. Erythroid stimulating agents had been or were being used in 36.8% of the lower risk patients, iron chelation in 31% of lower risk patients requiring red blood cell transfusions and lenalidomide in 41% of lower risk patients with del 5q. High-dose chemotherapy, hypomethylating agents, low dose cytarabine and allogeneic stem cell transplantation had been or were being used in 14.8%, 31.1%, 8.8% and 5.1%, respectively, of higher-risk patients.

Conclusions: Karyotype is now assessed in most patients with myelodysplastic syndromes, and patients under 65 years old may have more aggressive disease. Apart from erythroid-stimulating agents and, in higher-risk myelodysplastic syndromes, hypomethylating agents, specific treatments are used in a minority of patients with myelodysplastic syndromes and red blood cell transfusions still represent the major reason for hospital admission.

Figure 1.

(A). Treatment modalities according to IPSS (% of all treatments used during the preceding 6 months) in patients with IPSS low/int-1 (white columns) and IPSS int-2/high (gray columns). (B) Treatment modalities according to age (% of all treatments used during the preceding 6 months) in patients aged <65 years (white columns), 65–80 years (gray columns) and > 80 years (black columns). ESA: erythropoiesis-stimulating Agents; Allo SCT: allogeneic stem cell transplantation; Chemo HD: intensive anthracycline-cytarabine chemotherapy; Chemo LD, low-dose chemotherapy (including low-dose cytarabine, or less often hydroxyurea or 6-mercaptopurine); HM agents, hypomethylating agents; IS treatment, immunosuppressive treatment.