ESAs Before Transfusions Improve Outcomes Versus After Transfusions in MDS

Among patients with anemia related to lower-risk myelodysplastic syndromes (MDS), those who received erythropoiesis-stimulating agents (ESAs) after receiving red blood cell transfusions were older, had more comorbidities, and had worse survival versus those who received ESA prior to transfusions, according to an analysis of real-world French patients.

The data were presented by Abdessamia Gandoul, MD, of the Grenoble Alpes University Hospital in France, at the European Hematology Association 2024 Hybrid Congress in Madrid, Spain.

The retrospective analysis included 194 patients from 27 French hematology centers who had very low-, low-, or intermediate-risk MDS per the Revised International Prognostic Scoring System without 5q deletion and with hemoglobin under 10 g/dL

Overall, 46.4% (n=90) of the patients initiated ESAs for anemia prior to receiving red blood cell transfusion, while the remainder received ESAs after being transfused. The researchers reported 48% of all patients achieved an erythroid response, with a median duration of response of 16 months.

Patients in the transfusion-first group had a median age of 82 years compared with 78 years in the ESA-first group (P<.005). Additionally, 68.7% of patients in the transfusion-first group had a Charlson Comorbidity Index score greater than four compared with 44.4% in the ESA-first group (P=.003). Median hemoglobin levels at baseline were 8.3 g/dL in transfusion-first patients versus 9.2 g/dL in ESA-first patients (P<.001).

In the patients who received ESAs before transfusions, 68% eventually received transfusions due to lack of response to ESAs, and the response rate to second-line treatments, including luspatercept, was 47%.

“This real-life analysis highlights a specific population in France receiving transfusions prior to ESA treatment,” Dr. Gandoul summarized. “Those patients have more severe baseline characteristics, including older age, more comorbidities, and have poorer survival.”

Reference

Gandoul A, Chermat F, Meunier M, et al. Real-life anemia treatment in low-risk myelodysplastic syndrome (MDS) patients: a retrospective multicenter study by the Groupe Francophone des Myélodysplasies (GFM) on 194 patients. Abstract #P778. Presented at the European Hematology Association 2024 Hybrid Congress. June 13-16; Madrid, Spain.