Response to Frontline Therapy Predicts Improved OS in LR-MDS

Patients with lower-risk myelodysplastic syndromes (LR-MDS) who responded to frontline therapy had improved overall survival compared with patients who did not respond to frontline treatment, according to data from a retrospective study.

Rami S. Komrokji, MD, of Moffitt Cancer Center in Tampa, Florida, and colleagues studied 603 patients with LR-MDS who had received an erythropoiesis-stimulating agent (ESA) as frontline therapy. The majority of patients received epoetin (69%), with fewer receiving frontline darbepoetin (17%) or granulocyte colony stimulating factor (14%).

Forty-two percent of patients had hematologic improvement, with no difference in the rate of response among those with or without ring sideroblasts (RSs). However, patients who were not transfusion dependent had significantly improved response (52% vs 31%; P<.001).

About half of patients went on to receive second-line therapy, and the rate of hematologic improvement was 27%. No differences were seen based on RSs or transfusion dependence.

The researchers then divided the 331 patients who received frontline and second-line therapy into groups based on response to each. Group 1 was no response to frontline therapy and no response to second-line therapy (no/no); group 2 was no/yes; group 3 was yes/no; and group 4 was yes/yes.

Median overall survival was 114 months for yes/yes responders, 103 months for yes/no patients, 97 months for no/yes patients, and 64 months for no/no patients (P=.007). Those who responded to frontline treatment had significantly better overall survival after adjusting for RSs (hazard ratio, 0.74; 95% CI, 0.55-0.99; P=.043).

“Identifying and moving agents with high hematologic improvement rate as frontline therapy and or selecting option based on predictors of best chance of response to a specific treatment as frontline may lead to better overall survival,” the researchers concluded.

Reference

Komrokji RS, Ammad-ud-din M, Al Ali NH, et al. Hematological response to frontline treatment in lower risk myelodysplastic syndromes (LRMDS) is associated with better overall survival. Abstract #1867. Presented at the 65th American Society of Hematology Annual Meeting & Exposition; December 9-12, 2023; San Diego, California.