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Quality of life, physical function and MRI T2* in elderly low‐risk MDS patients treated to a haemoglobin level of ≥120 g/L with darbepoetin alfa ± filgrastim or erythrocyte transfusions

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Abstract

Objective:  Anaemia in low‐risk myelodysplastic syndromes (MDS) is associated with reduced quality of life (QoL). Response to treatment with erythropoietin ± granulocyte colony‐stimulating factor (G‐CSF) is associated with improved QoL, but whether transfusion therapy with higher haemoglobin (Hb) target levels has similar effects is unknown. The objective for this prospective phase II Nordic multicentre trial was to assess QoL, response rate and physical function in elderly anaemic MDS patients treated to a target Hb level of >120 g/L.

Methods:  Thirty‐six elderly patients with low‐ and intermediate‐1 risk MDS received darbepoetin (DA) 300 μg/wk, with the addition of G‐CSF if no response. If the Hb target was reached at 16 wk, treatment was maintained until week 26. Remaining patients were transfused to reach the target level for at least 8 wk.

Results:  Twenty‐seven patients completed the study. Response rate to DA ± G‐CSF was 67% in evaluable patients and 56% according to intention to treat. Eighteen patients reached the target Hb level according to protocol. QoL scores for fatigue, dyspnoea, constipation, and physical, role and social functioning improved significantly during study, with similar results for transfused and untransfused patients. Maintaining Hb >120 g/L did not confer a higher transfusion rate, once the target was reached. In two of fourteen patients, magnetic resonance imaging T2* indicated cardiac iron overload, however, without association with ferritin levels.

Conclusions:  In elderly anaemic MDS patients, an increment in haemoglobin is associated with improved QoL, whether induced by growth factor treatment or transfusion therapy.
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Document Type: Research Article

Affiliations: 1: Section of Hematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden 2: Department of Haematology, University Hospital, Uppsala, Sweden 3: Department of Clinical Science and Education, Department of Internal Medicine, Karolinska Institutet, Stockholm South Hospital, Stockholm, Sweden 4: Department of Hematology, University hospital, Linköping, Sweden 5: Department of Hematology, University Hospital MAS, Malmö, Sweden 6: Department of Medicine, Umeå University Hospital, Umeå, Sweden 7: Department of Hematology, Rigshospitalet, Copenhagen, Denmark 8: Department of Hematology, University Hospital, Lund, Sweden 9: Department of Hematology, Aarhus University Hospital, Aarhus, Denmark 10: Department of Medicine, Sundsvall Hospital, Sundsvall, Sweden 11: Department of Haematology and Faculty Division, Ullevål University Hospital, Oslo, Norway 12: Division of Hematology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden

Publication date: September 1, 2011

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