PF547 FACTORS ASSOCIATED WITH THE NEED FOR TRANSFUSIONS IN PATIENTS WITH LOWER RISK MYELODYSPLASTIC SYNDROME (MDS). DATA FROM THE REGULAR CARE MDS‐REGISTRY IN GERMANY

Abstract

Background:In 2009 we started a registry to evaluate the course of MDS in routine care in Germany.Aims:The aim of the current evaluation was to analyze factors associated with the need for red blood cell transfusions in patients (pts) with IPSS low and intermediate‐1 (int‐1) risk at diagnosis and in the course of the disease.Methods:2,447 patients (pts) with MDS were included in the regular care MDS‐registry from July 2009 till December 2016, provided that the diagnosis was confirmed by bone marrow biopsy and the pts had given their written informed consent. Baseline parameters at diagnosis and the clinical course were quarterly documented in an online database (IoStudy by Iomedico) by 90 centers all over Germany.imageResults:At the data‐cut in April 2017 1,240 of 2,428 evaluable pts (50.7%) had a low‐ (612 pts/49,4%) or an int‐1 ‐risk MDS (628 pts. /50.6%). The median age of the lower risk pts was 74 years (range 26–94), 484 (39%) were women and the median time of observation was 25 months (mo, range 0–97, mean 30,62mo). At diagnosis 114 (18.6%) low‐ and 169 (26.9%) int‐1‐ risk pts were transfusion‐dependent (TD). The median time to become TD was significantly different (log rank (Mantel‐Cox) p = <0.01) between low‐ (28mo, SD 4.030, 95% CI 20.1 – 35.9) and int‐1‐ risk pts (9mo, SD 1.380, 95% CI 6.295 – 11.705). Survival (OS) was estimated by Kaplan‐Meier curves for pts without TD mean 82,661mo (SD 1,813mo, 95%>CI 79,108 ‐ 86,214) and pts with TD mean 51,261mo (SD 1,453mo, 95%>CI 48,413 ‐ 54,109)(fig. 1A). Furthermore, OS after becoming TD was estimated by a time‐to‐TD stratified Kaplan‐Meyer curve (fig. 1B), that shows a significant difference (0.00 Log Rank, Mantel‐Cox). In an univariate analysis the following baseline parameters were significantly associated with a shorter duration to become TD: age ≥80years, hemoglobin (hb), count of reticulocytes, LDH, endogenous erythropoietin level (epo), ferritin, and fibrosis in bone marrow histology. The following parameters were not associated: sex, thrombocyte‐, leucocyte‐ and granulocyte‐count, folic‐acid‐, vitamin B12 level, and CRP. Del‐5q and trisomy 8 were the only cytogenetic abnormalities significantly associated with a shorter duration to become TD. In a cox regression analysis (table 1) hb and epo were significant only.imageSummary/Conclusion:The sooner pts becomes TD in the course of MDS, the poorer is the prognosis. It should be tested if a therapy that respites TD can prolong OS.Supported by an unrestricted grand from Celgene, Munich, Germany