title: Differences in community and academic practice patterns for newly diagnosed myelodysplastic syndromes (MDS) patients.
abstract: OBJECTIVE
  The heterogeneous nature of myelodysplastic syndromes (MDS) complicates therapeutic decision making, particularly for newly diagnosed disease. Factors impacting the treatment plan in this early period of disease course are poorly defined. This study determines whether therapeutic choices for newly diagnosed MDS are associated with location of treatment (community or academic), prognostic risk category, and patient age.
  
  
  METHODS
  The adults in Minnesota with myelodysplastic syndromes (AIMMS) database was utilized in this statewide, prospective population-based study conducted by the University of Minnesota (UMN), Mayo Clinic, and Minnesota Department of Health. Adult (age 20+ years) cases of MDS newly diagnosed starting in April 2010 were invited to participate. This analysis includes patients enrolled during the first study year with 1-year follow-up data. Treatment choices (supportive, active, and transplant) were stratified by the international prognostic scoring system (IPSS) and the revised-IPSS (IPSS-R), then separated into groups by location of care and age (<65 or 65+ years). Academic-based care was any contact with the UMN and Mayo Clinic; community-based care was all other clinical sites.
  
  
  RESULTS
  Stratification by IPSS and IPSS-R showed supportive care decreased and active care increased with advancing risk categories (p<0.0001). Comparing treatment setting, community-based care had 77% supportive and 23% active treatment; academic-based care was 36% supportive, 41% active, and 23% transplant (p<0.0001). By age groups, patients <65 years with intermediate, high, or very high risk disease by IPSS-R received 97% active care/transplant, compared to only 52% of patients age 65+.
  
  
  CONCLUSIONS
  Younger patients and those treated at academic centers had a more aggressive treatment approach. Whether these treatment differences convey improved disease control and mortality, and therefore should be extended more frequently to older and community-based patients, is the subject of ongoing prospective study.
authors.affiliation: Department of Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55415, United States. Electronic address: daniel.pease@hcmed.org.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Pease
authors.affiliation: Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, Minneapolis, MN 55454, United States; Masonic Cancer Center, University of Minnesota, MMC 806, 420 Delaware Street SE, Minneapolis, MN 55455, United States. Electronic address: rossx014@umn.edu.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Ross
authors.affiliation: Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, Minneapolis, MN 55454, United States; Masonic Cancer Center, University of Minnesota, MMC 806, 420 Delaware Street SE, Minneapolis, MN 55455, United States. Electronic address: poynt006@umn.edu.
authors.forename: Jenny N
authors.initials: JN
authors.lastname: Poynter
authors.affiliation: Division of Hematopathology, Hilton 8-60E, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. Electronic address: Nguyen.Phuong@mayo.edu.
authors.forename: Phuong L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: Department of Laboratory Medicine and Pathology, MMC 609, 420 Delaware Street SE, University of Minnesota, Minneapolis, MN 55455, United States; Masonic Cancer Center, University of Minnesota, MMC 806, 420 Delaware Street SE, Minneapolis, MN 55455, United States. Electronic address: hirsc003@umn.edu.
authors.forename: Betsy
authors.initials: B
authors.lastname: Hirsch
authors.affiliation: Hematopathology, VA Medical Center, 1 Veterans Drive, Minneapolis, MN 55417, United States. Electronic address: ciocm001@umn.edu.
authors.forename: Adina
authors.initials: A
authors.lastname: Cioc
authors.affiliation: Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, Minneapolis, MN 55454, United States; Masonic Cancer Center, University of Minnesota, MMC 806, 420 Delaware Street SE, Minneapolis, MN 55455, United States. Electronic address: roesl003@umn.edu.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Roesler
authors.affiliation: Hematology, Oncology and Transplantation, University of Minnesota, MMC 480, 420 Delaware Street SE, Minneapolis, MN 55455, United States. Electronic address: ewarlick@umn.edu.
authors.forename: Erica D
authors.initials: ED
authors.lastname: Warlick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011379:Prognosis; D012307:Risk Factors
keywords: Bone marrow transplantation; Drug therapy; Hematologic malignancies; Myelodysplastic syndromes