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Boccia R, Xiao H, von Wilamowitz-Moellendorff C, Raorane R, Deshpande S, Klijn SL, Yucel A. A Systematic Literature Review of Predictors of Erythropoiesis-Stimulating Agent Failure in Lower-Risk Myelodysplastic Syndromes. J Clin Med 2024; 13:2702. [PMID: 38731231 PMCID: PMC11084325 DOI: 10.3390/jcm13092702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/04/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Erythropoiesis-stimulating agents (ESAs) are the first-line treatment option for anemia in patients with lower-risk myelodysplastic syndromes (LR-MDS). A systematic literature review was conducted to identify evidence of the association between prognostic factors and ESA response/failure in LR-MDS. MEDLINE, Embase, and relevant conferences were searched systematically for studies assessing the association between prognostic factors and ESA response/failure in adult patients. Of 1566 citations identified, 38 were included. Patient risk status in studies published from 2000 onwards was commonly assessed using the International Prognostic Scoring System (IPSS) or revised IPSS. ESA response was generally assessed using the International Working Group MDS criteria. Among the included studies, statistically significant relationships were found, in both univariate and multivariate analyses, between ESA response and the following prognostic factors: higher hemoglobin levels, lower serum erythropoietin levels, and transfusion independence. Furthermore, other prognostic factors such as age, bone marrow blasts, serum ferritin level, IPSS risk status, and karyotype status did not demonstrate statistically significant relationships with ESA response. This systematic literature review has confirmed prognostic factors of ESA response/failure. Guidance to correctly identify patients with these characteristics could be helpful for clinicians to provide optimal treatment.
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Affiliation(s)
- Ralph Boccia
- The Center for Cancer and Blood Disorders, 6410 Rockledge Drive, Suite 660, Bethesda, MD 20817, USA
| | - Hong Xiao
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrence Township, NJ 08648, USA; (H.X.)
| | | | - Renuka Raorane
- Evidera, Ltd., UK Office, The Ark, 201 Talgarth Rd, London W6 8BJ, UK; (C.v.W.-M.); (R.R.)
| | - Sohan Deshpande
- Evidera, Ltd., UK Office, The Ark, 201 Talgarth Rd, London W6 8BJ, UK; (C.v.W.-M.); (R.R.)
| | - Sven L. Klijn
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrence Township, NJ 08648, USA; (H.X.)
| | - Aylin Yucel
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrence Township, NJ 08648, USA; (H.X.)
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2
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Vetro C, Di Giacomo V, Mannina D, Magrin S, Mulè A, Mitra ME, Siragusa S, Duminuco A, Garibaldi B, Vadalà MCE, Di Raimondo F, Palumbo GA. Response Assessment to Erythropoietin-Zeta (Epo-Alpha Biosimilar) Therapy in Low-Risk Myelodysplastic Syndromes. J Clin Med 2022; 11:jcm11061665. [PMID: 35329991 PMCID: PMC8951463 DOI: 10.3390/jcm11061665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/08/2022] [Accepted: 03/15/2022] [Indexed: 01/27/2023] Open
Abstract
Background. This prospective observational study aimed to verify the efficacy of erythropoietin zeta in the treatment of patients with low-risk myelodysplastic syndrome. Methods. Patients with low/int-1 IPSS risk and serum erythropoietin level below 500 U/L were enrolled. Treatment consisted of erythropoietin zeta 40,000 U subcutaneously once a week. The primary endpoint was the erythroid response. According to Simon’s two-stage statistical design, 36 patients were recruited. The median age was 75 years (range 56–83 years), male/female ratio was 1.1/1, median baseline serum erythropoietin was 57.9 U/L (range 9.4–475 U/L). 53% of patients had low-risk disease, while the remaining had Int-1 risk. Results. After 8 weeks, a significant response (rise in Hb levels of at least 1.5 g/dL) was achieved in 18 patients (50%) out of 36. However, 17 patients did not improve; 8/17 patients pursued the 40,000 U weekly schedule of erythropoietin zeta, and 4/8 (50%) of them reached the erythroid response after 16 weeks. Nine patients underwent dosage doubling (40,000 U twice per week), and 5/9 (55%) of them achieved the erythroid response. Conclusion. Compared with data from the literature, this prospective study revealed that EPO-zeta is a safe and effective therapeutic option in low-risk MDS patients.
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Affiliation(s)
- Calogero Vetro
- Division of Hematology, A.O.U. Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (C.V.); (M.C.E.V.); (F.D.R.)
| | - Valeria Di Giacomo
- Department of Hematology, Azienda Ospedaliera Papardo, 98158 Messina, Italy; (V.D.G.); (D.M.)
| | - Donato Mannina
- Department of Hematology, Azienda Ospedaliera Papardo, 98158 Messina, Italy; (V.D.G.); (D.M.)
| | - Silvana Magrin
- BMT Unit, Division of Hematology, V. Cervello Hospital, 90146 Palermo, Italy; (S.M.); (A.M.); (M.E.M.)
| | - Antonio Mulè
- BMT Unit, Division of Hematology, V. Cervello Hospital, 90146 Palermo, Italy; (S.M.); (A.M.); (M.E.M.)
| | - Maria Enza Mitra
- BMT Unit, Division of Hematology, V. Cervello Hospital, 90146 Palermo, Italy; (S.M.); (A.M.); (M.E.M.)
| | - Sergio Siragusa
- Hematology Unit, Thrombosis and Hemostasis Reference Regional Center, University of Palermo, 90127 Palermo, Italy;
| | - Andrea Duminuco
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy; (A.D.); (B.G.)
| | - Bruno Garibaldi
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy; (A.D.); (B.G.)
| | | | - Francesco Di Raimondo
- Division of Hematology, A.O.U. Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (C.V.); (M.C.E.V.); (F.D.R.)
| | - Giuseppe A. Palumbo
- Postgraduate School of Hematology, University of Catania, 95123 Catania, Italy; (A.D.); (B.G.)
- Department of Scienze Mediche, Chirurgiche e Tecnologie Avanzate “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy
- Correspondence:
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Hellström-Lindberg E, Tobiasson M, Greenberg P. Myelodysplastic syndromes: moving towards personalized management. Haematologica 2020; 105:1765-1779. [PMID: 32439724 PMCID: PMC7327628 DOI: 10.3324/haematol.2020.248955] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023] Open
Abstract
The myelodysplastic syndromes (MDS) share their origin in the hematopoietic stem cell but have otherwise very heterogeneous biological and genetic characteristics. Clinical features are dominated by cytopenia and a substantial risk for progression to acute myeloid leukemia. According to the World Health Organization, MDS is defined by cytopenia, bone marrow dysplasia and certain karyotypic abnormalities. The understanding of disease pathogenesis has undergone major development with the implementation of next-generation sequencing and a closer integration of morphology, cytogenetics and molecular genetics is currently paving the way for improved classification and prognostication. True precision medicine is still in the future for MDS and the development of novel therapeutic compounds with a propensity to markedly change patients' outcome lags behind that for many other blood cancers. Treatment of higher-risk MDS is dominated by monotherapy with hypomethylating agents but novel combinations are currently being evaluated in clinical trials. Agents that stimulate erythropoiesis continue to be first-line treatment for the anemia of lower-risk MDS but luspatercept has shown promise as second-line therapy for sideroblastic MDS and lenalidomide is an established second-line treatment for del(5q) lower-risk MDS. The only potentially curative option for MDS is hematopoietic stem cell transplantation, until recently associated with a relatively high risk of transplant-related mortality and relapse. However, recent studies show increased cure rates due to better tools to target the malignant clone with less toxicity. This review provides a comprehensive overview of the current status of the clinical evaluation, biology and therapeutic interventions for this spectrum of disorders.
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Affiliation(s)
- Eva Hellström-Lindberg
- Karolinska Institutet, Center for Hematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Tobiasson
- Karolinska Institutet, Center for Hematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Greenberg
- Stanford Cancer Institute, Division of Hematology, Stanford University School of Medicine, Stanford, CA, USA
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Balleari E, Filiberti RA, Salvetti C, Allione B, Angelucci E, Bruzzone M, Calzamiglia T, Cavaliere M, Cavalleri M, Cilloni D, Clavio M, Crisà E, Da Col A, Danise P, Pilo F, Ferrero D, Finelli C, Gioia D, Lemoli RM, Masiera E, Messa E, Miglino M, Musto P, Natalie Oliva E, Poloni A, Salvi F, Sanna A, Scudeletti M, Tassara R, Santini V. Effects of different doses of erythropoietin in patients with myelodysplastic syndromes: A propensity score-matched analysis. Cancer Med 2019; 8:7567-7576. [PMID: 31657156 PMCID: PMC6912022 DOI: 10.1002/cam4.2638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/15/2019] [Accepted: 10/05/2019] [Indexed: 11/29/2022] Open
Abstract
Background Erythropoiesis‐stimulating agents effectively improve the hemoglobin levels in a fraction of anemic patients with myelodysplastic syndromes (MDS). Higher doses (HD) of recombinant human erythropoietin (rhEPO) have been proposed to overcome suboptimal response rates observed in MDS patients treated with lower “standard doses” (SD) of rhEPO. However, a direct comparison between the different doses of rhEPO is lacking. Methods A cohort of 104 MDS patients treated with HD was retrospectively compared to 208 patients treated with SD in a propensity score‐matched analysis to evaluate hematological improvement‐erythroid (HI‐E) rate induced by the different doses of rhEPO. The impact of rhEPO doses on survival and progression to leukemia was also investigated. Results Overall HI‐E rate was 52.6%. No difference was observed between different rhEPO doses (P = .28) in matched cohorts; in a subgroup analysis, transfusion‐dependent patients and patients with higher IPSS‐R score obtained a higher HI‐E rate with HD, although without significant impact on overall survival (OS). Achievement of HI‐E resulted in superior OS. At univariate analysis, a higher HI‐E rate was observed in transfusion‐independent patients (P < .001), with a lower IPSS‐R score (P < .001) and lower serum EPO levels (P = .027). Multivariate analysis confirmed that rhEPO doses were not significantly related to HI‐E (P = .26). There was no significant difference in OS or progression to leukemia in patients treated with HD vs SD. Conclusion SD are substantially equally effective to HD to improve anemia and influencing survival in MDS patients stratified according to similar propensity to be exposed to rhEPO treatment.
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Affiliation(s)
- Enrico Balleari
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | | | - Chiara Salvetti
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, University of Turin, Torino, Italy
| | - Bernardino Allione
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, Molinette Hospital, Torino, Italy
| | - Emanuele Angelucci
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Marco Bruzzone
- UO Clinical Epidemiology, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Tullio Calzamiglia
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine-ASL 1, Sanremo (IM), Italy
| | - Marina Cavaliere
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine-ASL 2, Savona, Italy
| | - Maurizio Cavalleri
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine-ASL 4, Sestri Levante (GE), Italy
| | - Daniela Cilloni
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Department of Clinical and Biological Sciences, University of Turin, Torino, Italy
| | - Marino Clavio
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Clinic of Hematology, Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Elena Crisà
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, University of Turin, Torino, Italy
| | - Anna Da Col
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Paolo Danise
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, Nocera Hospital, Nocera Inferiore, Italy
| | - Federica Pilo
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology-P.O. Oncologico Businco AOG. Brotzu, Cagliari, Italy
| | - Dario Ferrero
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, University of Turin, Torino, Italy
| | - Carlo Finelli
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, AOU Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Daniela Gioia
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy
| | - Roberto Massimo Lemoli
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Clinic of Hematology, Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Elisa Masiera
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy
| | - Emanuela Messa
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine, ASLTo4, Carmagnola, Italy
| | - Maurizio Miglino
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Clinic of Hematology, Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Pellegrino Musto
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,Regional Department of Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (Pz), Italy
| | - Esther Natalie Oliva
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, Grande Ospedale Metropolitano "Bianchi Melacrino Morelli", Reggio Calabria, Italy
| | - Antonella Poloni
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, Università Politecnica delle Marche, Ancona, Italy
| | - Flavia Salvi
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, SS. Antonio e Biagio Hospital, Alessandria, Italy
| | - Alessandro Sanna
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,Ematologia, Ospedale di Livorno, Livorno, Italy
| | - Marco Scudeletti
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine-ASL 4, Sestri Levante (GE), Italy
| | - Rodolfo Tassara
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine-ASL 2, Savona, Italy
| | - Valeria Santini
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,MDS Unit, AOU Careggi, University of Florence, Firenze, Italy
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