PS1338 TEMPORAL TRENDS IN TRANSFUSION BURDEN AMONG NEWLY DIAGNOSED PATIENTS WITH MYELODYSPLASTIC SYNDROMES: A U.S. CLAIMS DATABASE STUDY

Abstract

Background:Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal hematologic stem cell disorders characterized by ineffective hematopoiesis resulting in peripheral cytopenias. Anemia is the most prevalent of all cytopenias and is often treated with red blood cell transfusion (RBCT). There is a paucity of data on how the transfusion requirements of MDS patients change early in their clinical course. Understanding the temporal changes in transfusion needs in patients with MDS can provide data on the clinical need of MDS‐specific therapies based on the pace and burden of transfusion dependency.Aims:This retrospective study assessed the status and temporal trends in RBCTs among newly diagnosed patients with MDS in the United States, using a large administrative claims data set, Optum Research Database.Methods:All patients aged ≥ 18 years with newly diagnosed MDS (≥ 2 medical claims with an International Classification of Diseases, 9th or 10th Revision [ICD‐9 or ICD‐10] diagnosis codes ≥ 30 days apart) and in continuous health plan enrollment for ≥ 6 months pre‐ and 3 months post‐index date between January 2012 and May 2018 were included. Index was defined as date of first diagnosis. Transfusion status was evaluated during the 6‐month pre‐, and at 3‐month, 6‐month, and 9‐month post‐index periods for patients managed with observation alone, or with RBCT with or without erythropoiesis‐stimulating agents (ESAs). Transfusion independence (TI) was defined as patients receiving no transfusions; transfusion users (TU) was defined as 1 transfusion episode; and transfusion dependence (TD) was defined as patients receiving ≥ 2 transfusions during the observation periods.Results:Among the 3,803 patients identified, 56.3% were male, 85.4% were ≥ 65 years old (median age was 76), 78.0% were enrolled in a Medicare Advantage with Part D plan, and mean Quan‐Charlson Comorbidity Index was 1.98. Most patients (61.7%) were diagnosed with MDS, unspecified (ICD‐9‐CM 238.75, ICD‐10‐CM D46.9) on index date. Anemia was the presenting cytopenia in 78.8% of patients and 24.4% needed ≥ 1 RBCT (11.5% were TD and 12.9% were TU) preceding the MDS diagnosis. Common comorbidities observed in the pre‐index period were: hypertension (69.6%), cardiac diseases (58.1%), and dyslipidemia (54.8%). ESAs were administered to 40.7% of patients during the post‐index period. During the 9 months following diagnosis, a steady increase in TD was observed (Table).Summary/Conclusion:Disease burden in patients with MDS remains considerable. Considering that RBCT needs increased steadily despite ESA use with up to 37% still reliant on RBCT at 9 months post diagnosis indicates a critical unmet need for newer therapies for MDS patients who have TD anemia and for whom limited therapies exist beyond ESAs and RBCT.image