Myelodysplastic syndromes and elderly patients

Advances in Therapy, 2011

Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal neoplasms with the median age at diagnosis being in the seventh decade. If left untreated, the disease progresses to acute myeloblastic leukemia (AML). There are many options for the management of MDS, but the only potentially curative treatment is allogenic hematopoietic stem cell transplantation (allo-HSCT), which is often not an option because of advanced age or comorbidities at diagnosis or lack of a human leukocyte antigen-identical donor. MDS in the elderly should be managed similar to that in young patients, but the fact that many advanced age patients cannot undergo allo-HSCT precludes any chance of cure. Despite the main objective of prolonging overall survival and the time to progression to AML, the key is to improve quality of life for the longest possible time. To achieve these objectives, supportive care is essential. Likewise, immunomodulatory drugs, such as lenalidomide, can reduce transfusion requirements and reverse cytologic and cytogenetic abnormalities in patients with MDS with chromosome 5q deletion. Elderly patients with high-risk MDS can benefit from 5-azacitidine (5-AZA), with efficacy and safety profiles comparable with those found in patients under 75 years of age. In any patient, predictive drug response scores are required in order to ensure more rational use of these medications.

Haematologica, 2012

Myelodysplastic syndromes and acute myeloid leukemia exemplify the complexity of treatment allocation in older patients as options range from best supportive care, non-intensive treatment (e.g. hypomethylating agents) to intensive chemotherapy/hematopoietic cell transplantation. Novel metrics for non-disease variables are urgently needed to help define the best treatment for each older patient. We investigated the feasibility and prognostic value of geriatric/quality of life assessments aside from established disease-specific variables in 195 patients aged 60 years or over with myelodysplastic syndromes/acute myeloid leukemia. These patients were grouped according to treatment intensity and assessed. Assessment consisted of eight instruments evaluating activities of daily living, depression, mental functioning, mobility, comorbidities, Karnofsky Index and quality of life. Patients with a median age of 71 years (range 60-87 years) with myelodysplastic syndromes (n=63) or acute myeloid leukemia (n=132) were treated either with best supportive care (n=47), hypomethylating agents (n=73) or intensive chemotherapy/hematopoietic cell transplantation (n=75). After selection of variables, pathological activities of daily living and quality of life/fatigue remained highly predictive for overall survival in the entire patient group beyond disease-related risk factors adverse cytogenetics and blast count of 20% or over. In 107 patients treated non-intensively activities of daily living of less than 100 (hazard ratio, HR 2.94), Karnofsky Index below 80 (HR 2.34) and quality of life/'fatigue' of 50 or over (HR 1.77) were significant prognosticators. Summation of adverse features revealed a high risk of death (HR 9.36). In-depth evaluation of older patients prior to individual treatment allocation is feasible and provides additional information to standard assessment. Patients aged 60 years or over with newly diagnosed myelodysplastic syndromes/acute myeloid leukemia and impairments in activities of daily living, Karnofsky Index below 80%, quality of life/'fatigue' of 50 or over, are likely to have poor outcomes.

European Oncology & Haematology, 2010

Myelodysplastic syndromes (MDS) represent one of the most challenging health-related problems in the elderly. As the population continues to age, MDS will become a more prominent medical problem with a significant effect on healthcare systems. MDS are characterised by dysplastic morphology in the bone marrow in association with ineffective haematopoiesis; there are various pathophysiological causes of these diseases, including genetic abnormalities within myeloid progenitors, altered epigenetics and changes in the bone marrow microenvironment. There is uncertainty about how to diagnose patients who may benefit from a specific treatment; in fact, MDS probably constitute several molecularly distinct entities that share common changes in blood and bone marrow. The International Prognostic Scoring System (IPSS) is a useful tool to guide treatment decisions, but revisions of the original IPSS are under way as it fails to consider many aspects of the treatment of MDS patients, especially ...

Clinical Interventions in Aging, 2009

Clinical Interventions in Aging, 2013

The introduction of hypomethylating agents in the treatment of myelodysplastic syndromes (MDS) has significantly changed the clinical scenario of these diseases, which afflict predominantly older individuals. However, some concerns regarding the optimal application of these innovative and costly agents in the treatment of geriatric high-risk MDS remain. We report here the case of a nonagenarian treated with hypomethylating agents achieving a long-lasting clinical response and a significant improvement in her functional status. Our case confirmed that functional status and biological status, rather than the chronological age alone, can substantially guide the plan of an appropriate treatment strategy in high-risk MDS patients; moreover, the current case emphasizes the need for targeted studies in the field of geriatric MDS in order to formulate guidelines on the appropriate use of these costly agents, so that candidate patients can receive adequate treatment to preserve their quality of life and life expectancy, but at the same time avoiding unnecessary costs deriving from the use of high-cost drugs for those in whom a significant therapeutic result cannot be reasonably expected.

Cancer, 2007

2019

Background. The etiology of MDS syndromes (myelodysplastic syndromes) is unknown. MDS is a disease of the elderly, mostly affects people over 50 years of age. Elderly patients with MDS are diagnosed at an earlier stage of the disease compared to younger people. Therapeutic options in MDS include treatment with high-dose chemotherapy with / without hematopoietic stem cell transplantation, treatment with low-dose chemotherapy, supportive care and symptomatic treatment. Transfusion of RBC (Red Blood Cells) concentrate and platelet concentrate is used in the majority of patients with MDS and it is the only form of therapy recommended for both patients with good and bad prognosis. Case report. A 77-year-old patient repeatedly hospitalized in the Clinic of Geriatrics for symptomatic anemia in myelodysplastic syndrome. Independent patient in the field of selfcare, living alone. Patient take many medicines from different groups. Patient with multidisease. Symptoms of the patient: weakness, ...

Journal of Clinical Oncology, 2010

Acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) primarily afflict older individuals. Hematopoietic cell transplantation (HCT) is generally not offered because of concerns of excess morbidity and mortality. Reduced-intensity conditioning (RIC) regimens allow increased use of allogeneic HCT for older patients. To define prognostic factors impacting long-term outcomes of RIC regimens in patients older than age 40 years with AML in first complete remission or MDS and to determine the impact of age, we analyzed data from the Center for International Blood and Marrow Transplant Research (CIBMTR).

Cancer, 2006

BACKGROUND. Elderly patients (age Ն 65 years) with acute myeloid leukemia (AML) generally have a poor prognosis. AML-type therapy results are often derived from studies in younger patients and may not apply to elderly AML. Many investigators and oncologists advocate, at times, only supportive care or frontline single agents, Phase I-II studies, low-intensity regimens, or 'targeted' therapies. However, baseline expectations for outcomes of elderly AML with 'standard' AML-type therapy are not well defined. The aim was to develop prognostic models for complete response (CR), induction (8-week) mortality, and survival rates in elderly AML, which would be used to advise oncologists and patients of expectations with standard AML type therapy, and to establish baseline therapy results against which novel strategies would be evaluated.

Disease-a-Month, 2010

Myelodysplastic syndromes (MDS) are essentially neoplastic disorders of the hematopoietic stem cell leading to bone marrow failure. "Myelo" in Greek means bone marrow and "dysplasia" is a cytologic abnormal morphology. 1 MDS is an age-dependent disorder with higher propensity of occurrence in older individuals. 2,3 There is a variable degree of ineffective hematopoiesis leading to cytopenia in 1 or more lines of cells. Associated complications include anemia, bleeding, infection, transfusion dependency, iron overload, and multi-organ failure from secondary causes. MDS is highly variable in its clinical course and can have a rather chronic course to an aggressive, high-risk disease leading to death within 6 months of initial presentation of cytopenia. MDS patients are at increased risk of progression to acute myeloid leukemia (AML). 1 MDS is among the top 5 causes of anemia in the elderly. 4 Unfortunately, it is often underdiagnosed and unrecognized. In the past few years, the US Food and Drug Administration (FDA) approved newer treatments for MDS patients, which provide help for patients and in some cases alter the natural history of the disease and improve patient survival. Epidemiology MDS is primarily a disease of old age and approximately 86% of the individuals diagnosed with this disease are older than 60. 2,3 The median age at the time of diagnosis is about 76. 2,3 The age-adjusted incident rate is higher in individuals who are older than the age of 80 with an incidence rate of 36.3/100,000 compared with an incidence rate of 0.1/100,000 in individuals younger than 30. 2 MDS became reportable to Surveillance, Epidemiology, and End Results Program (SEER) in 2001. 3 According to