@article{d17845db1b0243848a689896d3f29ac6,
title = "Erythropoiesis-stimulating agents significantly delay the onset of a regular transfusion need in nontransfused patients with lower-risk myelodysplastic syndrome",
abstract = "Background: The EUMDS registry is an unique prospective, longitudinal observational registry enrolling newly diagnosed patients with lower-risk myelodysplastic syndrome (MDS) from 17 European countries from both university hospitals and smaller regional hospitals. Objective: The aim of this study was to describe the usage and clinical impact of erythropoiesis-stimulating agents (ESAs) in 1696 patients enrolled between 2008 and 2014. Methods: The effects of ESAs on outcomes were assessed using proportional hazards models weighting observations by propensity to receive ESA treatment within a subset of anaemic patients with or without a regular transfusion need. Results: ESA treatment (median duration of 27.5 months, range 0–77 months) was administered to 773 patients (45.6%). Outcomes were assessed in 897 patients (484 ESA treated and 413 untreated). ESA treatment was associated with a nonsignificant survival benefit (HR 0.82, 95% CI: 0.65–1.04, P = 0.09); this benefit was larger amongst patients without prior transfusions (P = 0.07). Amongst 539 patients for whom response to ESA treatment could be defined, median time to first post-ESA treatment transfusion was 6.1 months (IQR: 4.3–15.9 months) in those transfused before ESA treatment compared to 23.3 months (IQR: 7.0–47.8 months) in patients without prior transfusions (HR 2.4, 95% CI: 1.7–3.3, P < 0.0001). Responding patients had a better prognosis in terms of a lower risk of death (HR 0.65, 95% CI: 0.45–0.893, P = 0.018), whereas there was no significant effect on the risk of progression to acute myeloid leukaemia (HR 0.71, 95% CI: 0.39–1.29, P = 0.27). Conclusion: Appropriate use of ESAs can significantly delay the onset of a regular transfusion need in patients with lower-risk MDS.",
keywords = "MDS, Myelodysplasia, anaemia, haematology, haemoglobin",
author = "Garelius, {H. K.G.} and Johnston, {W. T.} and Smith, {A. G.} and S. Park and {de Swart}, L. and P. Fenaux and A. Symeonidis and G. Sanz and J. {\v C}erm{\'a}k and R. Stauder and L. Malcovati and M. Mittelman and {van de Loosdrecht}, {A. A.} and {van Marrewijk}, {C. J.} and D. Bowen and S. Crouch and {de Witte}, {T. J.M.} and E. Hellstr{\"o}m-Lindberg",
note = "Publisher Copyright: {\textcopyright} 2016 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.",
year = "2017",
month = mar,
day = "1",
doi = "10.1111/joim.12579",
language = "אנגלית",
volume = "281",
pages = "284--299",
journal = "Journal of Internal Medicine",
issn = "0954-6820",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "3",
}