title: Recombinant human erythropoietin in very elderly patients with myelodysplastic syndromes: results from a retrospective study.
abstract: Myelodysplastic syndromes (MDS) are common in elderly patients. Recombinant human erythro-poietin (rHuEPO) has been widely used to treat anemia in lower risk MDS patients, but few data are known about rHuEPO treatment in the very elderly patient group. In order to investigate the role of rHuEPO treatment in terms of response, overall survival (OS), and toxicity in a very elderly MDS patient group, 93 MDS patients treated with rHuEPO when aged ≥80 years were selected among MDS cases enrolled in a retrospective multicenter study by the cooperative group Gruppo Romano Mielodisplasie (GROM) from Jan 2002 to Dec 2010. At baseline, median age was 82.7 (range 80-99.1) with a median hemoglobin (Hb) level of 9 g/dl (range 6-10.8). The initial dose of rHuEPO was standard (epoetin alpha 40,000 IU/week or epoetin beta 30,000 IU/week) in 59 (63.4 %) patients or high in 34 (36.6 %) (epoetin alpha 80,000 IU/week) patients. We observed an erythroid response (ER) in 59 (63.4 %) patients. No thrombotic event was reported. Independent predictive factors for ER were low transfusion requirement before treatment (p = 0.004), ferritin <200 ng/ml (p = 0.017), Hb >8 g/dl (p = 0.034), and a high-dose rHuEPO treatment (p = 0.032). Median OS from rHuEPO start was 49.3 months (95 % CI 27.5-68.4) in responders versus 30.6 months (95 % CI 7.3-53.8) in resistant patients (p = 0.185). In conclusion, rHuEPO treatment is safe and effective also in the very elderly MDS patients. However, further larger studies are warranted to evaluate if EPO treatment could be worthwhile in terms of quality of life and cost-efficacy in very old patients.
authors.affiliation: Sant'Andrea Hospital, Hematology Unit, Faculty of Medicine and Psychology, Sapienza University, Via di Grottarossa 1035, 00189, Rome, Italy, caterina.tatarelli@gmail.com.
authors.forename: Caterina
authors.initials: C
authors.lastname: Tatarelli
authors.forename: Anna Lina
authors.initials: AL
authors.lastname: Piccioni
authors.forename: Luca
authors.initials: L
authors.lastname: Maurillo
authors.forename: Virginia
authors.initials: V
authors.lastname: Naso
authors.forename: Roberta
authors.initials: R
authors.lastname: Battistini
authors.forename: Mariella
authors.initials: M
authors.lastname: D'Andrea
authors.forename: Marianna
authors.initials: M
authors.lastname: Criscuolo
authors.forename: Carolina
authors.initials: C
authors.lastname: Nobile
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Villivà
authors.forename: Stefano
authors.initials: S
authors.lastname: Mancini
authors.forename: Benedetta
authors.initials: B
authors.lastname: Neri
authors.forename: Massimo
authors.initials: M
authors.lastname: Breccia
authors.forename: Susanna
authors.initials: S
authors.lastname: Fenu
authors.forename: Francesco
authors.initials: F
authors.lastname: Buccisano
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Voso
authors.forename: Roberto
authors.initials: R
authors.lastname: Latagliata
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Aloe Spiriti
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D001803:Blood Transfusion / Q000706:statistics & numerical data; D004341:Drug Evaluation; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005293:Ferritins / Q000097:blood; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006400:Hematocrit; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D053208:Kaplan-Meier Estimate; D008297:Male; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D013927:Thrombosis / Q000139:chemically induced
chemical_list: D011994:Recombinant Proteins; C103998:epoetin beta; D004921:Erythropoietin; D000068817:Epoetin Alfa; D005293:Ferritins