Predictive factors of response and survival in myelodysplastic syndrome treated with erythropoietin and G-CSF: the GFM experience.
We analyzed prognostic factors of response, response duration, and possible impact on survival of epoetin alpha, epoetin beta, or darbepoetin alpha (DAR) with or without granulocyte colony-stimulating factor in 403 myelodysplastic syndrome (MDS) patients. Sixty-two percent (40% major and 22% minor) and 50% erythroid responses were seen, and median response duration was 20 and 24 months according to IWG 2000 and 2006 criteria, respectively. Significantly higher response rates were observed with less than 10% blasts, low and int-1 International Prognostic Scoring System (IPSS), red blood cell transfusion independence, serum EPO level less than 200 IU/L, and, with IWG 2006 criteria only, shorter interval between diagnosis and treatment. Significantly longer response duration was associated with major response (IWG 2000 criteria), IPSS low to INT-1, blasts less than 5%, and absence of multilineage dysplasia. Minor responses according to IWG 2000 were reclassified as "nonresponders" or "responders" according to IWG 2006 criteria. However, among those IWG 2000 minor responders, response duration did not differ between IWG 2006 responders and nonresponders. Multivariate adjusted comparisons of survival between our cohort and the untreated MDS cohort used to design IPSS showed similar rate of progression to acute myeloid leukemia in both cohorts, but significantly better overall survival in our cohort, suggesting that epoetin or DAR treatment may have a favorable survival impact in MDS.
Park
Sophie
S
Service d'hématologie, Hôpital Cochin, Assistance Publique des Hopitaux de Paris, Université Paris, France. sophie.park@cch.aphp.fr
Grabar
Sophie
S
Kelaidi
Charikleia
C
Beyne-Rauzy
Odile
O
Picard
Françoise
F
Bardet
Valérie
V
Coiteux
Valérie
V
Leroux
Geneviève
G
Lepelley
Pascale
P
Daniel
Marie-Thérèse
MT
Cheze
Stéphane
S
Mahé
Béatrice
B
Ferrant
Augustin
A
Ravoet
Christophe
C
Escoffre-Barbe
Martine
M
Adès
Lionel
L
Vey
Norbert
N
Aljassem
Lina
L
Stamatoullas
Aspasia
A
Mannone
Lionel
L
Dombret
Hervé
H
Bourgeois
Keith
K
Greenberg
Peter
P
Fenaux
Pierre
P
Dreyfus
François
F
D000368:Aged; D001752:Blast Crisis / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D015331:Cohort Studies; D018572:Disease-Free Survival; D017707:Erythrocyte Transfusion; D004921:Erythropoietin / Q000008:administration & dosage* / Q000493:pharmacokinetics; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage* / Q000493:pharmacokinetics; D006801:Humans; D008297:Male; D009190:Myelodysplastic Syndromes / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D011237:Predictive Value of Tests; D015996:Survival Rate; D013997:Time Factors
D004921:Erythropoietin; D016179:Granulocyte Colony-Stimulating Factor