TY - JOUR
T1 - Impact of treatment with iron chelation therapy in patients with lower-risk myelodysplastic syndromes participating in the European MDS registry
AU - EUMDS Registry Participants
AU - Hoeks, Marlijn
AU - Yu, Ge
AU - Langemeijer, Saskia
AU - Crouch, Simon
AU - de Swart, Louise
AU - Fenaux, Pierre
AU - Symeonidis, Argiris
AU - Čermák, Jaroslav
AU - Hellström-Lindberg, Eva
AU - Sanz, Guillermo
AU - Stauder, Reinhard
AU - Holm, Mette Skov
AU - Mittelman, Moshe
AU - Mądry, Krzysztof
AU - Malcovati, Luca
AU - Tatic, Aurelia
AU - Almeida, Antonio Medina
AU - Germing, Ulrich
AU - Savic, Aleksandar
AU - Gredelj Šimec, Njetočka
AU - Culligan, Dominic
AU - Itzykson, Raphael
AU - Guerci-Bresler, Agnes
AU - Slama, Borhane
AU - van de Loosdrecht, Arjan
AU - van Marrewijk, Corine
AU - Droste, Jackie
AU - Blijlevens, Nicole
AU - van Kraaij, Marian
AU - Bowen, David
AU - de Witte, Theo
AU - Smith, Alex
N1 - Funding Information: The EUMDS Registry is supported by an educational grant from Novartis Pharmacy B.V. Oncology Europe, and Amgen Limited. This work is part of the MDS-RIGHT activities, which has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 634789 - “Providing the right care to the right patient with MyeloDysplastic Syndrome at the right time”. Publisher Copyright: © 2020 Ferrata Storti Foundation Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Iron overload due to red blood cell (RBC) transfusions is associated with morbidity and mortality in lower-risk myelodysplastic syndrome (MDS) patients. Many studies have suggested improved survival after iron chelation therapy (ICT), but valid data are limited. The aim of this study was to assess the effect of ICT on overall survival and hematologic improvement in lower-risk MDS patients in the European MDS registry. We compared chelated patients with a contemporary, non-chelated control group within the European MDS registry, that met the eligibility criteria for starting iron chelation. A Cox proportional hazards model was used to assess overall survival (OS), treating receipt of chelation as a time-varying variable. Additionally, chelated and non-chelated patients were compared using a propensity-score matched model. Of 2,200 patients, 224 received iron chelation. The hazard ratio and 95% confidence interval for OS for chelated patients, adjusted for age, sex, comorbidity, performance status, cumulative RBC transfusions, Revised-International Prognostic Scoring System (IPSS-R), and presence of ringed sideroblasts was 0.50 (0.34-0.74). The propensity-score analysis, matched for age, sex, country, RBC transfusion intensity, ferritin level, comorbidity, performance status, and IPSS-R, and, in addition, corrected for cumulative RBC transfusions and presence of ringed sideroblasts, demonstrated a significantly improved OS for chelated patients with a hazard ratio of 0.42 (0.27-0.63) compared to non-chelated patients. Up to 39% of chelated patients reached an erythroid response. In conclusion, our results suggest that iron chelation may improve OS and hematopoiesis in transfused lower-risk MDS patients. This trial was registered at clinicaltrials.gov identifier: 00600860.
AB - Iron overload due to red blood cell (RBC) transfusions is associated with morbidity and mortality in lower-risk myelodysplastic syndrome (MDS) patients. Many studies have suggested improved survival after iron chelation therapy (ICT), but valid data are limited. The aim of this study was to assess the effect of ICT on overall survival and hematologic improvement in lower-risk MDS patients in the European MDS registry. We compared chelated patients with a contemporary, non-chelated control group within the European MDS registry, that met the eligibility criteria for starting iron chelation. A Cox proportional hazards model was used to assess overall survival (OS), treating receipt of chelation as a time-varying variable. Additionally, chelated and non-chelated patients were compared using a propensity-score matched model. Of 2,200 patients, 224 received iron chelation. The hazard ratio and 95% confidence interval for OS for chelated patients, adjusted for age, sex, comorbidity, performance status, cumulative RBC transfusions, Revised-International Prognostic Scoring System (IPSS-R), and presence of ringed sideroblasts was 0.50 (0.34-0.74). The propensity-score analysis, matched for age, sex, country, RBC transfusion intensity, ferritin level, comorbidity, performance status, and IPSS-R, and, in addition, corrected for cumulative RBC transfusions and presence of ringed sideroblasts, demonstrated a significantly improved OS for chelated patients with a hazard ratio of 0.42 (0.27-0.63) compared to non-chelated patients. Up to 39% of chelated patients reached an erythroid response. In conclusion, our results suggest that iron chelation may improve OS and hematopoiesis in transfused lower-risk MDS patients. This trial was registered at clinicaltrials.gov identifier: 00600860.
UR - http://www.scopus.com/inward/record.url?scp=85075016771&partnerID=8YFLogxK
U2 - https://doi.org/10.3324/haematol.2018.212332
DO - https://doi.org/10.3324/haematol.2018.212332
M3 - Article
C2 - 31278207
SN - 0390-6078
VL - 105
SP - 640
EP - 651
JO - Haematologica
JF - Haematologica
IS - 3
ER -