Abstract

The impact on health care of patients with myelodysplastic syndromes (MDS) is continuously rising. To investigate the perception of hemato-oncologists concerning the recommended MDS patient care in Switzerland, we conducted a web-based survey on diagnosis, risk-stratification and treatment. 43/309 physicians (13.9%) replied to 135 questions that were based on current guidelines between 3/2017 and 2/2018. Only questions with feedback-rates >50% were further analysed and ratios >90% defined “high agreement”, 70–90% “agreement”, 30–70% “insufficient agreement” and <30% “disagreement”. For diagnosis, we found insufficient agreement on using flow-cytometry, classifying MDS precursor conditions, performing treatment response assessment after hypomethylating agents (HMA) and evaluating patients with suspected germ-line predisposition. For risk-stratification, we identified agreement on using IPSS-R but insufficient agreement for IPSS and patient-based assessments. For treatment, we observed disagreement on performing primary infectious prophylaxis in neutropenia but agreement on using only darbepoetin alfa in anaemic, lower-risk MDS patients. For thrombopoietin receptor agonists, insufficient agreement was found for the indication, preferred agent and triggering platelet count. Insufficient agreement was also found for immunosuppressive treatment in hypoplastic MDS and HMA dose adjustments. In conclusion, we identified areas for improvement in MDS patient care, in need of further clinical trials, information, and guiding documents.

Highlights

  • Guidelines and recommendations (G/Rs) for the diagnostic work-up and treatment of adult patients with myelodysplastic syndromes (MDS) are published [1,2,3]

  • The survey was initiated by the Swiss MDS Study Group (SMSG), an independent, research consortium of hemato-oncologists practicing in Switzerland

  • There was high agreement on the need of bone marrow (BM) examination at suspected diagnosis (43/43, 100%) and progression, while insufficient agreement was found on the assessment of response to hypomethylating agents (HMA) (20/43, 46.5%)

Read more

Summary

Introduction

Guidelines and recommendations (G/Rs) for the diagnostic work-up and treatment of adult patients with myelodysplastic syndromes (MDS) are published [1,2,3]. The level of adherence in the daily clinical practice remains unclear, both in Switzerland and in many other countries. MDS represent a heterogeneous group of hematopoietic stem cell disorders with a variable risk of transformation into secondary acute myeloid leukemia (AML). The syndromes are diagnosed at a median age above 70 years and characterized by cytopenias, dysplasia and inflammation [4,5]. Due to aging of the population and the integration of generation sequencing (NGS) in the diagnostic evaluation of unclear cytopenias, we are observing an increase of MDS cases in recent years. The heterogeneity of the disease, complexity of management and multi-morbidity of the mainly elderly

Results
Discussion
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call