Making MDS Treatment Decisions Easier

Higher risk myelodysplastic syndrome responds best to stem cell transplants

(RxWiki News) A big challenge with cancer treatment has to do with knowing whether or not the patient will respond well to treatment. Scientists have come up with a model that answers this question for one disorder that can lead to cancer.

One of the most common blood disorders in people over the age of 60 is myelodysplastic syndrome (MDS). At its worst, MDS can lead to leukemia, a type of blood cancer.

Stem cell transplants, which replace damaged blood cells with new cells, are the only way to cure MDS.

In this study, scientists have learned that patients with high-risk MDS respond best to stem cell transplants, while lower-risk MDS patients lived longer with non-transplant therapies.

"Ask your doctor about different treatment options for your condition."

The international study was led by Boston-based Dana-Farber Cancer Institute scientists.

This study's leaders included John Koreth, MBBS, DPhil, medical oncologist in the Division of Hematologic Malignancies at Dana-Farber, Joseph Pidala, MD, MS, of the H. Lee Moffitt Cancer & Research Institute and Corey Cutler, MD, MPH, of the Division of Hematologic Malignancies at Dana-Farber.

"Our study helps inform older MDS patients and their doctors whether a stem cell transplant is preferred or whether it makes more sense to pursue other options," Dr. Koreth said in a news release.

"Until now, there haven’t been statistically-quantified guidelines for making these decisions for older patients, who are most impacted by the disease," he said.

MDS, which is diagnosed in about 12,000 Americans every year, develops in the bone marrow. The disorder leads to a drop in white and red blood cells and platelets. MDS symptoms can include easy bruising and bleeding, fatigue, shortness of breath, infection and fever.

The only tool currently used to describe the severity of the disease is the International Prognostic Scoring System (IPSS). This system classifies patients into lower- and higher-risk categories.

Currently, patients who have lower-risk MDS are treated with a number of medications, blood transfusions and other therapies. Individuals with higher-risk forms of MDS typically receive chemotherapy.

These therapies only work to treat the symptoms, not cure the disease. Only stem cell transplants, using cells from a matched donor (family member or stranger), can cure MDS.

While any MDS patient can choose to undergo a stem cell transplant, doctors have not known who benefits most from the procedure — until now.

For this study, the researchers analyzed data from 513 newly diagnosed MDS patients between the ages of 60 and 70.

The scientists developed mathematical models to compare the outcomes of patients who received stem cell transplants to those of patients who were treated with other therapies.

This study looked both at how long the patients lived and their quality of life.

Patients with low-risk MDS who received transplants lived an average of 38 months compared to 77 months for those who received non-transplant treatments.

In contrast, people with higher-risk MDS who received donor stem cell transplants lived an average of 38 months, compared to the average 28 months for those who didn’t have transplants.

"These simple but robust findings may help clinical decision making for the older patient with MDS," the authors concluded.

Findings from this research were published June 24 in the Journal of Clinical Oncology.

No funding information was provided. Two of the authors disclosed financial ties with Celgene.

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Review Date: 
June 24, 2013