Overall survival in lower IPSS risk MDS by receipt of iron chelation therapy, adjusting for patient-related factors and measuring from time of first red blood cell transfusion dependence: an MDS-CAN analysis Academic Article uri icon

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abstract

  • Analyses suggest iron overload in red blood cell (RBC) transfusion-dependent (TD) patients with myleodysplastic syndrome (MDS) portends inferior overall survival (OS) that is attenuated by iron chelation therapy (ICT) but may be biassed by unbalanced patient-related factors. The Canadian MDS Registry prospectively measures frailty, comorbidity and disability. We analysed OS by receipt of ICT, adjusting for these patient-related factors. TD International Prognostic Scoring System (IPSS) low and intermediate-1 risk MDS, at RBC TD, were included. Predictive factors for OS were determined. A matched pair analysis considering age, revised IPSS, TD severity, time from MDS diagnosis to TD, and receipt of disease-modifying agents was conducted. Of 239 patients, 83 received ICT; frailty, comorbidity and disability did not differ from non-ICT patients. Median OS from TD was superior in ICT patients (5·2 vs. 2·1 years; P < 0·0001). By multivariate analysis, not receiving ICT independently predicted inferior OS, (hazard ratio for death 2·0, P = 0·03). In matched pair analysis, OS remained superior for ICT patients (P = 0·02). In this prospective, non-randomized analysis, receiving ICT was associated with superior OS in lower IPSS risk MDS, adjusting for age, frailty, comorbidity, disability, revised IPSS, TD severity, time to TD and receiving disease-modifying agents. This provides additional evidence that ICT may confer clinical benefit.

authors

  • Leitch, Heather A
  • Parmar, Ambica
  • Wells, Richard A
  • Chodirker, Lisa
  • Zhu, Nancy
  • Nevill, Thomas J
  • Yee, Karen WL
  • Leber, Brian
  • Keating, Mary-Margaret
  • Sabloff, Mitchell
  • St. Hilaire, Eve
  • Kumar, Rajat
  • Delage, Robert
  • Geddes, Michelle
  • Storring, John M
  • Kew, Andrea
  • Shamy, April
  • Elemary, Mohamed
  • Lenis, Martha
  • Mamedov, Alexandre
  • Ivo, Jessica
  • Francis, Janika
  • Zhang, Liying
  • Buckstein, Rena

publication date

  • October 2017

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