Anemia is the most common cytopenia found in MDS
References 1Wilde L, Pan J. Clin Lymphoma Myeloma Leuk. 2019;19:758-762.

Up to 90% of patients with MDS develop anemia, and about half of those have Hb < 10 g/dL
References 2Zeidan AM et al. Blood Rev. 2019;34:1-15.
References 3Sekeres MA Taylor J. JAMA. 2022;328:872-880.

Most cases of MDS are idiopathic in nature and patients typically present with non-specific signs and symptoms. Observed cytopenias include anemia, neutropenia, thrombocytopenia, or pancytopenia.

References 2Zeidan AM et al. Blood Rev. 2019;34:1-15.
References 3Sekeres MA Taylor J. JAMA. 2022;328:872-880.
References 4Weinberg OK, Hasserjian RP. Semin Hematol. 2019;56:15-21.

Anemia is an important cause of morbidity and mortality in MDS
References 5Malcovati L et al. Haematologica. 2011;96:1433-1440.
References 6Platzbecker U et al. Leukemia. 2021;35:2182-2198.

References 7Greenberg PL et al. Blood. 2012;120:2454-2465. 

Data are from combined international databases of 7012 patients with primary untreated MDS used to create the IPSS-R

References 7Greenberg PL et al. Blood. 2012;120:2454-2465. 

AML, acute myeloid leukemia; Hb, hemoglobin, IPSS-R, Revised International Prognostic Scoring System.

  • Severe anemia is associated with a higher prognostic risk, a shorter overall survival (OS), and a more rapid evolution to acute myeloid leukemia (AML)
    References 7Greenberg PL et al. Blood. 2012;120:2454-2465. 
References 5Malcovati L et al. Haematologica. 2011;96:1433-1440.

Reproduced with permission from Haematologica.

References 5Malcovati L et al. Haematologica. 2011;96:1433-1440.

Data based on a prospective, observational cohort analysis of 840 patients with MDS in Pavia, Italy, and 504 patients with MDS in Düsseldorf, Germany. Cox regression analyses were performed, including age, Hb categories, WHO subgroups, cytogenetic risk groups categorized according to the IPSS, number of cytopenias, and cardiac disease as time-dependent covariates.

References 5Malcovati L et al. Haematologica. 2011;96:1433-1440.

Hb, hemoglobin; HR, hazard ratio; IPSS, International Prognostic Scoring System; WHO, World Health Organization.

 

  • Cardiac diseases, including coronary artery disease, congestive heart failure, myocardial infarction, arrhythmia, and heart valve disease, were the most frequently observed comorbidities of anemia
    References 5Malcovati L et al. Haematologica. 2011;96:1433-1440.
  • Males with Hb levels < 9 g/dL and females with Hb levels < 8 g/dL had significantly more frequent cardiac disease and death compared with those with higher Hb levels (incidence rate ratio [IRR]: 1.70 and 4.22, respectively)
    References 5Malcovati L et al. Haematologica. 2011;96:1433-1440.

 

 

 

Transfusion dependence negatively impacts the survival of patients with MDS
References 8Malcovati L et al. Haematologica. 2006;91:1588-1590.
References 9Hiwase DK et al. Am J Hematol. 2017;92:508-514.
References 10Braga Lemos M et al. Eur J Haematol. 2021;107:3-23.

References 11Rozema J et al. Transfusion. 2021;61:2877-2884.
References 12Oliva EN et al. Blood Rev. 2021;50:100851.
References 13Balducci L. Cancer. 2006;106:2087-2094.

  of patients with MDS receive RBC transfusions for anemiaa

 of patients receive regular transfusions, with 46.6% considered

as having high transfusion burden (HTB) and 5.8% with low transfusion burden (LTB)b

aData based on a Surveillance, Epidemiology, and End Results (SEER) registry analysis of patients with MDS from 2001 to 2007.

References 14Ramsey SD et al. Vox Sang. 2012;102:331-337.

bData based on an observational, retrospective, population-based study using the HemoBase registry, including 292 patients diagnosed with MDS between 2005 and 2017 in the Netherlands. Transfusion burden was defined according to the International Working Group (IWG) 2018 guidelines: non-transfusion dependent (NTD; ≤ 2 U/16 wk), LTB (3-7 U/16 wk), and HTB (≥ 8 U/16 wk).

References 11Rozema J et al. Transfusion. 2021;61:2877-2884.

cData based on a practice and treatment survey of 30 European centers.

References 13Balducci L. Cancer. 2006;106:2087-2094.

 

  • About half of patients with MDS develop transfusion dependence within 2 years of diagnosis because of its chronicity
    References 11Rozema J et al. Transfusion. 2021;61:2877-2884.
    References 12Oliva EN et al. Blood Rev. 2021;50:100851.
    References 13Balducci L. Cancer. 2006;106:2087-2094.
  • Some patients with MDS may require more frequent transfusions with disease progression
    References 13Balducci L. Cancer. 2006;106:2087-2094.
References 8Malcovati L et al. Haematologica. 2006;91:1588-1590.

Reproduced with permission from Haematologica.

References 8Malcovati L et al. Haematologica. 2006;91:1588-1590.

Data based on a retrospective cohort of 426 Italian patients with MDS studied between 1992 and 2004.

References 8Malcovati L et al. Haematologica. 2006;91:1588-1590.

PRBC, packed red blood cells.

 

  • The effect of transfusion dependence is more noticeable in patients with low-risk myelodysplastic syndromes (LR-MDS) and is associated with the severity of transfusion requirements, expressed as the number of packed red blood cells (PRBC) units per month (U/4 wk). An increased transfusion requirement can be an independent predictor of shorter survival
    References 8Malcovati L et al. Haematologica. 2006;91:1588-1590.
References 10Braga Lemos M et al. Eur J Haematol. 2021;107:3-23.

  transfusion-independent (TI) vs transfusion-dependent (TD)

 decreased risk of death
References 10Braga Lemos M et al. Eur J Haematol. 2021;107:3-23.

 

Hazard ratio (HR): 0.44 (95% Cl: 0.34-0.55) 

Data based on a multiple Cox regression analysis in a meta-analysis of 4874 patients with MDS from 11 studies that reported OS outcomes for TI vs TD patients at baseline. Interpretation of these data may be limited because most of the studies in this meta-analysis were from observational, retrospective cohorts and abstracts with response rates and follow-up descriptions missing in large part. Confounders may also be present due to some heterogeneity in study parameters, study design, clinical characteristics, definitions, reliability of results, and risk curves.

References 10Braga Lemos M et al. Eur J Haematol. 2021;107:3-23.

 

  • Patients with MDS who are transfusion independent have a 56% decreased risk of death compared with those who require transfusions
    References 10Braga Lemos M et al. Eur J Haematol. 2021;107:3-23.
  • The HR global effect for OS in the pooled analysis was 0.44 (95% confidence interval [Cl]: 0.34-0.55). Most other clinical outcomes, such as AML progression, non-leukemic death, and progression-free survival (PFS), were also associated or had a trend toward worse prognosis in TD patients
    References 10Braga Lemos M et al. Eur J Haematol. 2021;107:3-23.

Frequent transfusions may also cause significant clinical complications
References 12Oliva EN et al. Blood Rev. 2021;50:100851.
References 13Balducci L. Cancer. 2006;106:2087-2094.

Transfused patients with MDS have a greater incidence of comorbid conditions compared with non-transfused patients
References 15Goldberg SL et al. J Clin Oncol. 2010;28:2847-2852.

Comorbid conditions

Reproduced with permission from J Clin Oncol.

References 15Goldberg SL et al. J Clin Oncol. 2010;28:2847-2852.

Data based on a retrospective review of US Medicare claims of beneficiaries aged ≥ 65 years in 2003 with a 3-year follow-up. A limitation of this study lies in the use of claims data, which are less detailed and have less accurate clinical information. These types of data may also be at risk for over- and/or under-reporting due to coding and naming discrepancies.

References 15Goldberg SL et al. J Clin Oncol. 2010;28:2847-2852.

  • Among patients receiving transfusions, 82.4% were diagnosed with a cardiac event compared with 67.1% who did not receive transfusions. Diabetes, dyspnea, hepatic disease, and infectious diseases also had a higher prevalence in patients with MDS receiving transfusions during the 3-year follow-up
    References 15Goldberg SL et al. J Clin Oncol. 2010;28:2847-2852.

Living with MDS places a heavy burden on patients’ daily lives
References 20Ria R et al. Clin Interv Aging. 2009;4:413-423.
References 21Stauder R et al. Leukemia. 2018;32:1380-1392.

  • Several studies have shown that the health-related quality of life of patients with MDS is significantly worse compared with the general population
    References 20Ria R et al. Clin Interv Aging. 2009;4:413-423.
    References 21Stauder R et al. Leukemia. 2018;32:1380-1392.
  • Similarly, caregivers also suffer in a manner similar to patients, reporting a high degree of distress and below average emotional, social, and functional wellbeing
    References 22DiNardo KW et al. Blood. 2022;140:8122-8123
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Physical problems

  • MDS causes a substantial and persistent functional decrement in a variety of areas, partially due to fatigue
    References 20Ria R et al. Clin Interv Aging. 2009;4:413-423.
  • 41% of patients with MDS reported moderate or severe mobility issues
    References 21Stauder R et al. Leukemia. 2018;32:1380-1392.

Data from a study of 1985 newly diagnosed patients in the European Myelodysplastic Syndromes Registry (EUMDS) registry with IPSS low or intermediate-1 MDS compared with the general population in Europe matched on age and sex.

References 21Stauder R et al. Leukemia. 2018;32:1380-1392.

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Emotional problems

  • Patients have often viewed the emotional impact of MDS as being more problematic than the physical consequences
    References 20Ria R et al. Clin Interv Aging. 2009;4:413-423.
  • 37.9% of patients with MDS reported moderate or severe issues with anxiety/depression
    References 21Stauder R et al. Leukemia. 2018;32:1380-1392.

Data from a study of 1985 newly diagnosed patients in the EUMDS registry with IPSS low or intermediate-1 MDS compared with the general population in Europe matched on age and sex.

References 21Stauder R et al. Leukemia. 2018;32:1380-1392.

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Role functioning

  • The disease may affect employment, necessitating time off from work or otherwise compromising career opportunities
    References 23Soper J et al. Patient Relat Outcome Meas. 2022;13:31-38.
  • 36.1% of patients with MDS reported moderate or severe problems with usual activities (eg, work, housework, or leisure activities)
    References 21Stauder R et al. Leukemia. 2018;32:1380-1392.

Data from a study of 1985 newly diagnosed patients in the EUMDS registry with IPSS low or intermediate-1 MDS compared with the general population in Europe matched on age and sex.

References 21Stauder R et al. Leukemia. 2018;32:1380-1392.

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Social functioning

  • Transfusion requirements may disrupt routines and take time and attention away from family and friends
    References 23Soper J et al. Patient Relat Outcome Meas. 2022;13:31-38.
  • 34% of patients receiving blood transfusions felt their transfusions were a burden to family
    References 24Sekeres MA et al. Oncologist. 2011;16:904-911.

Data from an internet-based survey of 358 patients with MDS, of whom 234 were receiving transfusions.

References 24Sekeres MA et al. Oncologist. 2011;16:904-911.

  • 1 Wilde L, Pan J. Clin Lymphoma Myeloma Leuk. 2019;19:758-762.
  • 2
    Zeidan AM et al. Blood Rev. 2019;34:1-15.
  • 3
    Sekeres MA Taylor J. JAMA. 2022;328:872-880.
  • 4 Weinberg OK, Hasserjian RP. Semin Hematol. 2019;56:15-21.
  • 5
    Malcovati L et al. Haematologica. 2011;96:1433-1440.
  • 6 Platzbecker U et al. Leukemia. 2021;35:2182-2198.
  • 7
    Greenberg PL et al. Blood. 2012;120:2454-2465. 
  • 8
    Malcovati L et al. Haematologica. 2006;91:1588-1590.
  • 9 Hiwase DK et al. Am J Hematol. 2017;92:508-514.
  • 10
    Braga Lemos M et al. Eur J Haematol. 2021;107:3-23.
  • 11
    Rozema J et al. Transfusion. 2021;61:2877-2884.
  • 12
    Oliva EN et al. Blood Rev. 2021;50:100851.
  • 13
    Balducci L. Cancer. 2006;106:2087-2094.
  • 14 Ramsey SD et al. Vox Sang. 2012;102:331-337.
  • 15
    Goldberg SL et al. J Clin Oncol. 2010;28:2847-2852.
  • 16
    Thein SL et al. Haematologica. 2020;105:539-544.
  • 17 Molina-Aguilar R et al. Transfus Med Hemother. 2020;47:152-159.
  • 18 Zalpuri S et al. BMJ Open. 2012;2:e001150.
  • 19
    Weber S et al. Front Immunol. 2020;11:627662. 
  • 20
    Ria R et al. Clin Interv Aging. 2009;4:413-423.
  • 21
    Stauder R et al. Leukemia. 2018;32:1380-1392.
  • 22 DiNardo KW et al. Blood. 2022;140:8122-8123
  • 23
    Soper J et al. Patient Relat Outcome Meas. 2022;13:31-38.
  • 24
    Sekeres MA et al. Oncologist. 2011;16:904-911.