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Park S, Kosmider O, Maloisel F, Drenou B, Chapuis N, Lefebvre T, Karim Z, Puy H, Alary AS, Ducamp S, Verdier F, Bouilloux C, Rousseau A, Jacob MC, Debliquis A, Charpentier A, Gyan E, Anglaret B, Leyronnas C, Corm S, Slama B, Cheze S, Laribi K, Amé S, Rose C, Lachenal F, Toma A, Pica GM, Carre M, Garban F, Mariette C, Cahn JY, Meunier M, Herault O, Fenaux P, Wagner-Ballon O, Bardet V, Dreyfus F, Fontenay M. Dyserythropoiesis evaluated by the RED score and hepcidin:ferritin ratio predicts response to erythropoietin in lower-risk myelodysplastic syndromes. Haematologica 2018; 104:497-504. [PMID: 30287621 PMCID: PMC6395339 DOI: 10.3324/haematol.2018.203158] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/02/2018] [Indexed: 12/29/2022] Open
Abstract
Erythropoiesis-stimulating agents are generally the first line of treatment of anemia in patients with lower-risk myelodysplastic syndrome. We prospectively investigated the predictive value of somatic mutations, and biomarkers of ineffective erythropoiesis including the flow cytometry RED score, serum growth-differentiation factor-15, and hepcidin levels. Inclusion criteria were no prior treatment with erythropoiesis-stimulating agents, low- or intermediate-1-risk myelodysplastic syndrome according to the International Prognostic Scoring System, and a hemoglobin level <10 g/dL. Patients could be red blood cell transfusion-dependent or not and were given epoetin zeta 40 000 IU/week. Serum erythropoietin level, iron parameters, hepcidin, flow cytometry Ogata and RED scores, and growth-differentiation factor-15 levels were determined at baseline, and molecular analysis by next-generation sequencing was also conducted. Erythroid response (defined according to the International Working Group 2006 criteria) was assessed at week 12. Seventy patients, with a median age of 78 years, were included in the study. There were 22 patients with refractory cytopenia with multilineage dysplasia, 19 with refractory cytopenia with unilineage dysplasia, 14 with refractory anemia with ring sideroblasts, four with refractory anemia with excess blasts-1, six with chronic myelomonocytic leukemia, two with del5q-and three with unclassifiable myelodysplastic syndrome. According to the revised International Prognostic Scoring System, 13 had very low risk, 47 had low risk, nine intermediate risk and one had high-risk disease. Twenty patients were transfusion dependent. Forty-eight percent had an erythroid response and the median duration of the response was 26 months. At baseline, non-responders had significantly higher RED scores and lower hepcidin:ferritin ratios. In multivariate analysis, only a RED score >4 (P=0.05) and a hepcidin:ferritin ratio <9 (P=0.02) were statistically significantly associated with worse erythroid response. The median response duration was shorter in patients with growth-differentiation factor-15 >2000 pg/mL and a hepcidin:ferritin ratio <9 (P=0.0008 and P=0.01, respectively). In multivariate analysis, both variables were associated with shorter response duration. Erythroid response to epoetin zeta was similar to that obtained with other erythropoiesis-stimulating agents and was correlated with higher baseline hepcidin:ferritin ratio and lower RED score. ClinicalTrials.gov registration: NCT 03598582.
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Affiliation(s)
- Sophie Park
- Department of Hematology, CHU Grenoble-Alpes, Grenoble .,Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Grenoble
| | - Olivier Kosmider
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service d'Hématologie Biologique, Hôpitaux Universitaires Paris Centre, Institut Cochin, Université Paris Descartes
| | | | - Bernard Drenou
- Department of Hematology, Hôpital Emile Muller, CH de Mulhouse
| | - Nicolas Chapuis
- INSERM UMR1149, CNRS 8252 - Centre de Recherche sur l'Inflammation (CRI) Equipe "Hème, Fer et Pathologies Inflammatoires", Labex GREX, Centre Français des Porphyries - Hôpital Louis Mourier HUPNVS, Paris
| | - Thibaud Lefebvre
- Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris Descartes University
| | - Zoubida Karim
- INSERM UMR1149, CNRS 8252 - Centre de Recherche sur l'Inflammation (CRI) Equipe "Hème, Fer et Pathologies Inflammatoires", Labex GREX, Centre Français des Porphyries - Hôpital Louis Mourier HUPNVS, Paris
| | - Hervé Puy
- INSERM UMR1149, CNRS 8252 - Centre de Recherche sur l'Inflammation (CRI) Equipe "Hème, Fer et Pathologies Inflammatoires", Labex GREX, Centre Français des Porphyries - Hôpital Louis Mourier HUPNVS, Paris
| | - Anne Sophie Alary
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service d'Hématologie Biologique, Hôpitaux Universitaires Paris Centre, Institut Cochin, Université Paris Descartes
| | - Sarah Ducamp
- Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris Descartes University
| | - Frédérique Verdier
- Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris Descartes University
| | - Cécile Bouilloux
- Department of Hematology, CHU Grenoble-Alpes, Grenoble.,Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Grenoble
| | - Alice Rousseau
- Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris Descartes University
| | | | | | | | | | | | | | | | | | | | | | - Shanti Amé
- Department of Hematology, Hôpital Civil, CHU Strasbourg
| | - Christian Rose
- Department of Hematology, Hôpital Saint Vincent de Paul, Lille
| | | | - Andrea Toma
- Department of Hematology, Hôpital Universitaire Henri Mondor, AP-HP, Université Paris 12, Créteil
| | | | - Martin Carre
- Department of Hematology, CHU Grenoble-Alpes, Grenoble.,Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Grenoble
| | - Frédéric Garban
- Department of Hematology, CHU Grenoble-Alpes, Grenoble.,Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Grenoble
| | - Clara Mariette
- Department of Hematology, CHU Grenoble-Alpes, Grenoble.,Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Grenoble
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble-Alpes, Grenoble.,Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Grenoble
| | - Mathieu Meunier
- Department of Hematology, CHU Grenoble-Alpes, Grenoble.,Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Grenoble
| | | | - Pierre Fenaux
- Department of Hematology, Saint Louis Hospital, AP-HP, Université Paris Diderot
| | - Orianne Wagner-Ballon
- Département d'Hématologie et Immunologie Biologiques, Hôpital Universitaire Henri Mondor, Creteil
| | - Valerie Bardet
- Service d'Hématologie Immunologie Transfusion, Hôpitaux Universitaires Paris Ile de France-Ouest, AP-HP
| | | | - Michaela Fontenay
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service d'Hématologie Biologique, Hôpitaux Universitaires Paris Centre, Institut Cochin, Université Paris Descartes
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