Abstract
BackgroundIn most patients, anemia is present when myelodysplastic syndrome is diagnosed. Although darbepoetin α is the first-choice supportive therapy for low-risk myelodysplastic syndrome, half of all patients develop a loss of response to darbepoetin α within 12 months. However, few reports have described supportive therapy after the loss of response to darbepoetin α.Case presentationWe herein present a case involving a 65-year-old Japanese woman with low-risk myelodysplastic syndrome whose erythropoiesis-stimulating agent treatment was switched from darbepoetin α to epoetin β pegol (continuous erythropoietin receptor activator) to treat transfusion-dependent anemia. The frequent transfusions required to treat the anemia resulted in transfusion-associated circulatory overload. The transfusion-dependent anemia was initially treated with darbepoetin α, which negated the requirement for transfusion. However, after 12 months of darbepoetin α therapy, the hemoglobin concentration sharply declined. We switched her therapy from darbepoetin α to continuous erythropoietin receptor activator to avoid transfusion. After initiation of continuous erythropoietin receptor activator therapy, the hemoglobin concentration gradually increased and transfusion was not required. At the time of writing, no progression of the anemia had occurred.ConclusionsAlthough darbepoetin α is the first-choice supportive therapy for low-risk myelodysplastic syndrome, continuous erythropoietin receptor activator might be considered the second-choice therapy.
Highlights
In most patients, anemia is present when myelodysplastic syndrome is diagnosed
We describe the use of Continuous erythropoietin receptor activator (CERA) as supportive therapy in a patient with Myelodysplastic syndrome (MDS) who experienced a loss of response to Darbepoetin α (DPO) through a switch from DPO to CERA
Iron deficiency was ruled out after testing. This decrease in hemoglobin was considered to be caused by the development of DPO resistance, which can occur during erythropoiesis-stimulating agents (ESAs) use in patients with MDS
Summary
Myelodysplastic syndrome (MDS) is a malignant hematopoietic disease. Typical clinical features of MDS include ineffective hematopoiesis, which is caused by excessive premature apoptosis of hematopoietic precursors at disease onset [1]. Case presentation A 65-year-old Japanese woman diagnosed with MDS by bone marrow aspiration had been treated at a core hospital since 2008 She had refractory anemia as defined by the World Health Organization classification and was categorized in the low-risk group (Int-1) as defined by the International Prognostic Scoring System. Her serum erythropoietin level was low (127 mIU/mL), so she began treatment with epoetin α at 9000 IU/week plus DPO at 40 μg/week, which are the usual treatment dosages for renal anemia in our clinic Her anemia rapidly progressed while receiving ten transfusions during her dialysis sessions until June 2015; this treatment strategy was based on consultations with a hematologist. No progression of the anemia occurred for 1 year, and her hemoglobin concentration was stable at >10 g/dL (Fig. 1)
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