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Rochau U, Stojkov I, Conrads-Frank A, Borba HH, Koinig KA, Arvandi M, van Marrewijk C, Garelius H, Germing U, Symeonidis A, Sanz GF, Fenaux P, de Witte T, Efficace F, Siebert U, Stauder R. Development of a core outcome set for myelodysplastic syndromes - a Delphi study from the EUMDS Registry Group. Br J Haematol 2020; 191:405-417. [PMID: 32410281 PMCID: PMC8221029 DOI: 10.1111/bjh.16654] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/18/2020] [Indexed: 12/11/2022]
Abstract
Treatment options for myelodysplastic syndromes (MDS) vary widely, depending on the natural disease course and patient‐related factors. Comparison of treatment effectiveness is challenging as different endpoints have been included in clinical trials and outcome reporting. Our goal was to develop the first MDS core outcome set (MDS‐COS) defining a minimum set of outcomes that should be reported in future clinical studies. We performed a comprehensive systematic literature review among MDS studies to extract patient‐ and/or clinically relevant outcomes. Clinical experts from the European LeukemiaNet MDS (EUMDS) identified 26 potential MDS core outcomes and participated in a three‐round Delphi survey. After the first survey (56 experts), 15 outcomes met the inclusion criteria and one additional outcome was included. The second round (38 experts) resulted in six included outcomes. In the third round, a final check on plausibility and practicality of the six included outcomes and their definitions was performed. The final MDS‐COS includes: health‐related quality of life, treatment‐related mortality, overall survival, performance status, safety, and haematological improvement. This newly developed MDS‐COS represents the first minimum set of outcomes aiming to enhance comparability across future MDS studies and facilitate a better understanding of treatment effectiveness.
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Affiliation(s)
- Ursula Rochau
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Igor Stojkov
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Annette Conrads-Frank
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Helena H Borba
- Department of Pharmacy, Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil
| | - Karin A Koinig
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Marjan Arvandi
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Corine van Marrewijk
- Department of Hematology, Radboud university medical center, Nijmegen, the Netherlands
| | - Hege Garelius
- Department of Medicine, Section of Hematology and Coagulation, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, Universitätsklinik Düsseldorf, Düsseldorf, Germany
| | - Argiris Symeonidis
- Department of Internal Medicine, Division of Hematology, University of Patras Medical School, Patras, Greece
| | - Guillermo F Sanz
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - Pierre Fenaux
- Service d'Hématologie, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris (AP-HP) and Université Paris 7, Paris, France
| | - Theo de Witte
- Department of Tumor Immunology - Nijmegen Center for Molecular Life Sciences, Radboud university medical center, Nijmegen, the Netherlands
| | - Fabio Efficace
- Health Outcomes Research Unit, Gruppo Italiano Malattie Ematologiche dell'Adulto (GIMEMA), Rome, Italy
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria.,Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Reinhard Stauder
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
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Angelucci E, Li J, Greenberg P, Wu D, Hou M, Montano Figueroa EH, Rodriguez MG, Dong X, Ghosh J, Izquierdo M, Garcia-Manero G. Iron Chelation in Transfusion-Dependent Patients With Low- to Intermediate-1-Risk Myelodysplastic Syndromes: A Randomized Trial. Ann Intern Med 2020; 172:513-522. [PMID: 32203980 DOI: 10.7326/m19-0916] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Iron chelation therapy (ICT) in patients with lower-risk myelodysplastic syndromes (MDS) has not been evaluated in randomized studies. OBJECTIVE To evaluate event-free survival (EFS) and safety of ICT in iron-overloaded patients with low- or intermediate-1-risk MDS. DESIGN Multicenter, randomized, double-blind, placebo-controlled trial (TELESTO). (ClinicalTrials.gov: NCT00940602). SETTING 60 centers in 16 countries. PARTICIPANTS 225 patients with serum ferritin levels greater than 2247 pmol/L; prior receipt of 15 to 75 packed red blood cell units; and no severe cardiac, liver, or renal abnormalities. INTERVENTION Deferasirox dispersible tablets (10 to 40 mg/kg per day) (n = 149) or matching placebo (n = 76). MEASUREMENTS The primary end point was EFS, defined as time from date of randomization to first documented nonfatal event (related to cardiac or liver dysfunction and transformation to acute myeloid leukemia) or death, whichever occurred first. RESULTS Median time on treatment was 1.6 years (interquartile range [IQR], 0.5 to 3.1 years) in the deferasirox group and 1.0 year (IQR, 0.6 to 2.0 years) in the placebo group. Median EFS was prolonged by approximately 1 year with deferasirox versus placebo (3.9 years [95% CI, 3.2 to 4.3 years] vs. 3.0 years [CI, 2.2 to 3.7 years], respectively; hazard ratio, 0.64 [CI, 0.42 to 0.96]). Adverse events occurred in 97.3% of deferasirox recipients and 90.8% of placebo recipients. Exposure-adjusted incidence rates of adverse events (≥15 events per 100 patient treatment-years) in deferasirox versus placebo recipients, respectively, were 24.7 versus 23.9 for diarrhea, 21.8 versus 18.7 for pyrexia, 16.7 versus 22.7 for upper respiratory tract infection, and 15.9 versus 0.9 for increased serum creatinine concentration. LIMITATIONS The protocol was amended from a phase 3 to a phase 2 study, with a reduced target sample size from 630 to 210 participants. There was differential follow-up between treatment groups. CONCLUSION The findings support ICT in iron-overloaded patients with low- to intermediate-1-risk MDS, with longer EFS compared with placebo and a clinically manageable safety profile. Therefore, ICT may be considered in these patients. PRIMARY FUNDING SOURCE Novartis Pharma AG.
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Affiliation(s)
- Emanuele Angelucci
- Hematology and Transplant Center, IRCCS Ospedale Policlinico San Martino, Genova, Italy (E.A.)
| | - Junmin Li
- Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (J.L.)
| | - Peter Greenberg
- Stanford University Medical Center, Stanford, California (P.G.)
| | - Depei Wu
- Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China (D.W.)
| | - Ming Hou
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China (M.H.)
| | | | - Maria Guadalupe Rodriguez
- Department of Hematology, Hospital de Especialidades, Centro Médico Nacional La Raza, IMSS, Mexico City, Mexico (M.G.R.)
| | - Xunwei Dong
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey (X.D., J.G.)
| | - Jagannath Ghosh
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey (X.D., J.G.)
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Jin X, He X, Cao X, Xu P, Xing Y, Sui S, Wang L, Meng J, Lu W, Cui R, Ni H, Zhao M. Iron overload impairs normal hematopoietic stem and progenitor cells through reactive oxygen species and shortens survival in myelodysplastic syndrome mice. Haematologica 2018; 103:1627-1634. [PMID: 29903757 PMCID: PMC6165791 DOI: 10.3324/haematol.2018.193128] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/07/2018] [Indexed: 12/27/2022] Open
Abstract
There is increasing clinical evidence to suggest a suppressive effect on hematopoiesis in myelodysplastic syndrome patients with iron overload. However, how iron overload influences hematopoiesis in myelodysplastic syndrome (MDS) remains unknown. Here, the RUNX1S291fs-transduced bone marrow mononuclear cells were yielded and transplanted into lethally irradiated recipient mice together with radioprotective bone marrow cells to generate MDS mice. Eight weeks post transplantation, the recipient mice received an intraperitoneal injection of 0.2 mL iron dextran at a concentration of 25 mg/mL once every other day for a total of 8 times to establish an iron overload model. In the present study, we show that iron overload impairs the frequency and colony-forming capacity of normal hematopoietic stem and progenitor cells, especially in erythroid, in MDS mice, which is due, at least in part, to growth differentiation factor 11-induced reactive oxygen species, shortening survival of MDS mice. Given that we are the first to construct an iron overload model in MDS mice, we hope this model will be helpful for further exploring the influence and mechanism of iron overload on MDS.
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Affiliation(s)
- Xin Jin
- Nankai University School of Medicine, Tianjin, PR China
| | - Xiaoyuan He
- Nankai University School of Medicine, Tianjin, PR China
| | - Xiaoli Cao
- Tianjin Children's Hospital, Tianjin, PR China
| | - Ping Xu
- Department of Hematology, Tianjin First Central Hospital, Tianjin, PR China
| | - Yi Xing
- Tianjin Children's Hospital, Tianjin, PR China
| | - Songnan Sui
- Department of Hematology, Tianjin First Central Hospital, Tianjin, PR China
| | - Luqiao Wang
- Department of Hematology, Tianjin First Central Hospital, Tianjin, PR China
| | - Juanxia Meng
- Department of Hematology, Tianjin First Central Hospital, Tianjin, PR China
| | - Wenyi Lu
- Department of Hematology, Tianjin First Central Hospital, Tianjin, PR China
| | - Rui Cui
- Department of Hematology, Tianjin First Central Hospital, Tianjin, PR China
| | - Hongyan Ni
- Department of Radiology, Tianjin First Central Hospital, Tianjin, PR China
| | - Mingfeng Zhao
- Department of Hematology, Tianjin First Central Hospital, Tianjin, PR China .,Nankai University School of Medicine, Tianjin, PR China
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Valent P, Stauder R, Theurl I, Geissler K, Sliwa T, Sperr WR, Bettelheim P, Sill H, Pfeilstöcker M. Diagnosis, management and response criteria of iron overload in myelodysplastic syndromes (MDS): updated recommendations of the Austrian MDS platform. Expert Rev Hematol 2018; 11:109-116. [PMID: 29292655 DOI: 10.1080/17474086.2018.1420473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Despite the availability of effective iron chelators, transfusion-related morbidity is still a challenge in chronically transfused patients with myelodysplastic syndromes (MDS). In these patients, transfusion-induced iron overload may lead to organ dysfunction or even organ failure. In addition, iron overload is associated with reduced overall survival in MDS. Areas covered: During the past 10 years, various guidelines for the management of MDS patients with iron overload have been proposed. In the present article, we provide our updated recommendations for the diagnosis, prevention and therapy of iron overload in MDS. In addition, we propose refined treatment response criteria. As in 2006 and 2007, recommendations were discussed and formulated by participants of our Austrian MDS platform in a series of meetings in 2016 and 2017. Expert commentary: Our updated recommendations should support early recognition of iron overload, optimal patient management and the measurement of clinical responses to chelation treatment in daily practice.
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Affiliation(s)
- Peter Valent
- a Department of Internal Medicine I, Division of Hematology & Hemostaseology , Medical University of Vienna , Vienna , Austria.,b Ludwig Boltzmann Cluster Oncology , Medical University of Vienna , Vienna , Austria
| | - Reinhard Stauder
- c Department of Internal Medicine V (Hematology and Oncology) , Medical University Innsbruck , Innsbruck , Austria
| | - Igor Theurl
- d Department of Internal Medicine II (Infectious Diseases, Immunology, Rheumatology, Pneumology) , Medical University Innsbruck , Innsbruck , Austria
| | - Klaus Geissler
- e Vth Medical Department with Hematology, Oncology and Palliative Medicine , Hospital Hietzing , Vienna , Austria
| | - Thamer Sliwa
- f 3rd Medical Department , Hanusch Hospital , Vienna , Austria
| | - Wolfgang R Sperr
- a Department of Internal Medicine I, Division of Hematology & Hemostaseology , Medical University of Vienna , Vienna , Austria.,b Ludwig Boltzmann Cluster Oncology , Medical University of Vienna , Vienna , Austria
| | - Peter Bettelheim
- g Department of Internal Medicine , Elisabethinen Hospital , Linz , Austria
| | - Heinz Sill
- h Division of Hematology, Department of Internal Medicine , Medical University of Graz , Graz , Austria
| | - Michael Pfeilstöcker
- b Ludwig Boltzmann Cluster Oncology , Medical University of Vienna , Vienna , Austria.,f 3rd Medical Department , Hanusch Hospital , Vienna , Austria
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