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338 Home blood transfusions: feasibility and safety, three years of experience in myelodysplastic syndromes
Posters / Leukemia Research 35 (2011) S27–S142
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43.3% (P < 0.001); 70.4% vs 45.4% (P< 0.05); 62.7% vs 44.4% (P = NS) after 8, 16, 24 weeks respectively. Response rate was significantly influenced by transfusion dependence (P < 0.05) and basal serum EPO level (P < 0.001). Mean Hb value was 94±11 g/l before therapy; 113±19 (p < 0.001); 116±18 (p < 0.001); 114±17 (p < 0.001) after 8, 16, 24 weeks respectively (Fig. 1).
years and Dm follow up 28(3–119) months. Anemia (hemoglobulin < 10 g/dL) or/and neutropenia (neutrophils <1800/mL) or/and thrombocytopenia (platelets < 100000/mL) was/were present in 28/43 patients. Cytogenetics were found normal in 8 examined patients. All patients were treated with EPO in Dm time 1(0.5–92) months from diagnosis, at Dm Hb 9.7(8–11) g/dl, while 20 of them were RBC transfusion dependent receiving Dm 2(1–4) RBC units every 4 weeks. According to the International Working Group criteria of 2006 for MDS, 28/43 (65%) patients responded in Dm time 2(1–21) months after treatment initiation, among them 6/20 (30%) patients were transfusion dependent. In multivariate analysis the need for RBC transfusion prior treatment and age at diagnosis >70 years were found unfavorable prognostic factors for response and long response duration (p < 0.05). Hb < 9.5 g/dl at diagnosis was shown an unfavorable prognostic factor for response duration only in univariate analysis (p < 0.05). Seven responders (7/28) developed refractoriness to EPO. The 7-year overall survival was 40% (Dm 41 months) while MDS-RA subtype, age <70 years, the initial EPO response and female gender favored prognosis. In this study, it is shown that in a considerable number of older patients ineligible for aggressive treatment, EPO administration improved the quality of life by reducing RBC transfusion needs and transfusion complications in association with acceptable overall survival. Larger series with more specific patient populations are needed to confirm these results.
Fig. 1. Hb (g/l) values (: Mean; Vertical bars:)
338 Home blood transfusions: feasibility and safety, three years of experience in myelodysplastic syndromes
Reduction or suspension of therapy significantly affected Hb level after 4 (P< 0.01) and 8 weeks (P< 0.01). Conversely, restart of full dosage significantly enhanced again Hb level after 4 (P< 0.01) and 8 weeks (P< 0.01) (Fig.2).
Fig. 2. Effects of reduction/suspension and subseq 59% patients are alive (mean survival 74 weeks): 70% with “very low” and 38% in “low/intermediate” risk MDS (P < 0.001). Treatment was well tolerated. 337 Erythropoietin in patients with myelodysplastic syndrome of refractory anemia and refractory anemia with excess blasts-1 subtypes; efficacy and prognostic factors D. Bartzoudis1 , A. Karpouza1 , A. Piperidou2 , M. Papadopoulou1 . 1 General Hospital of Katerini, Katerini, 2 Aristotle University of Thessaloniki, Thessaloniki, Greece Erythropoietin (EPO) is widely used to treat anemia of patients with myelodysplastic syndrome (MDS) in order to reduce red blood cell (RBC) transfusions or even achieve RBC transfusion independency. We investigated the efficacy of erythropoietin administration in 43 patients with myelodysplastic syndrome (MDS) of refractory anemia (MDS-RA, 32/43 patients) and refractory anemia with excess blasts-1 (MDS RAEB-1, 11/43 patients) subtypes. Nineteen males and 24 females were analyzed, with Dm age 73(55–85)
P. Boulanger1 , T. Comont2 , J. Moeglin2 , M.-F. Thiercelin-Legrand1 , 3 P. Cougoul2 , C. Recher ´ , O. Beyne-Rauzy2 . 1 Home Services, Sant´e 2 Relais 31, Internal Medicine, 3 Hematology, Purpan Universitary Hospital, Toulouse, France Background: Transfusion-dependence is a common issue in myelodysplastic syndromes (MDS) including low risk MDS after EPO failure or supportive care in high risk MDS. Purpose: Red blood cells (RBC) transfusions are usually performed at hospital. Alternative solutions are available through the development of home blood transfusion services in collaboration with the general practitioner [1,2]. We report our experience of home blood transfusions in MDS patients. Patients and Methods: Since 2009 our hospital developed home blood transfusion services. More than 220 red blood cell transfusions were made at home. We studied indications, safety, cost and feasibility of this modality of transfusion in comparison with standard procedure i.e. in hospitalization. Results: 116 transfusions were made in 25 patients. Mean age was 78.6 years (53–96). 16/25 patients (64%) suffered from myelodysplastic syndromes (MDS) or secondary acute myeloid leukemia (AML). Patients experienced no major adverse. In 10 cases transfusion was not possible due to nurse or general practitioner inaccessibility. No patient refused this modality of transfusion. Economic costs were evaluated: home transfusion appeared to be less expansive. Conclusion: home transfusion is safe and feasible. To receive treatment at home is a common patient’s preference and increase quality of life particularly in chronic disease which affects elderly people. Home supportive care represent an alternative solution if both patient and general practitioner are agree, that could improve hospital accessibility for more severe procedures. Reference(s) [1] Remonnay R et al. Bull Cancer 2008;95:1039–45. [2] Ademokun A et al. Transfusion Medicine 2005;15:219–22.
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43.3% (P < 0.001); 70.4% vs 45.4% (P< 0.05); 62.7% vs 44.4% (P = NS) after 8, 16, 24 weeks respectively. Response rate was significantly influenced by transfusion dependence (P < 0.05) and basal serum EPO level (P < 0.001). Mean Hb value was 94±11 g/l before therapy; 113±19 (p < 0.001); 116±18 (p < 0.001); 114±17 (p < 0.001) after 8, 16, 24 weeks respectively (Fig. 1).
years and Dm follow up 28(3–119) months. Anemia (hemoglobulin < 10 g/dL) or/and neutropenia (neutrophils <1800/mL) or/and thrombocytopenia (platelets < 100000/mL) was/were present in 28/43 patients. Cytogenetics were found normal in 8 examined patients. All patients were treated with EPO in Dm time 1(0.5–92) months from diagnosis, at Dm Hb 9.7(8–11) g/dl, while 20 of them were RBC transfusion dependent receiving Dm 2(1–4) RBC units every 4 weeks. According to the International Working Group criteria of 2006 for MDS, 28/43 (65%) patients responded in Dm time 2(1–21) months after treatment initiation, among them 6/20 (30%) patients were transfusion dependent. In multivariate analysis the need for RBC transfusion prior treatment and age at diagnosis >70 years were found unfavorable prognostic factors for response and long response duration (p < 0.05). Hb < 9.5 g/dl at diagnosis was shown an unfavorable prognostic factor for response duration only in univariate analysis (p < 0.05). Seven responders (7/28) developed refractoriness to EPO. The 7-year overall survival was 40% (Dm 41 months) while MDS-RA subtype, age <70 years, the initial EPO response and female gender favored prognosis. In this study, it is shown that in a considerable number of older patients ineligible for aggressive treatment, EPO administration improved the quality of life by reducing RBC transfusion needs and transfusion complications in association with acceptable overall survival. Larger series with more specific patient populations are needed to confirm these results.
Fig. 1. Hb (g/l) values (: Mean; Vertical bars:)
338 Home blood transfusions: feasibility and safety, three years of experience in myelodysplastic syndromes
Reduction or suspension of therapy significantly affected Hb level after 4 (P< 0.01) and 8 weeks (P< 0.01). Conversely, restart of full dosage significantly enhanced again Hb level after 4 (P< 0.01) and 8 weeks (P< 0.01) (Fig.2).
Fig. 2. Effects of reduction/suspension and subseq 59% patients are alive (mean survival 74 weeks): 70% with “very low” and 38% in “low/intermediate” risk MDS (P < 0.001). Treatment was well tolerated. 337 Erythropoietin in patients with myelodysplastic syndrome of refractory anemia and refractory anemia with excess blasts-1 subtypes; efficacy and prognostic factors D. Bartzoudis1 , A. Karpouza1 , A. Piperidou2 , M. Papadopoulou1 . 1 General Hospital of Katerini, Katerini, 2 Aristotle University of Thessaloniki, Thessaloniki, Greece Erythropoietin (EPO) is widely used to treat anemia of patients with myelodysplastic syndrome (MDS) in order to reduce red blood cell (RBC) transfusions or even achieve RBC transfusion independency. We investigated the efficacy of erythropoietin administration in 43 patients with myelodysplastic syndrome (MDS) of refractory anemia (MDS-RA, 32/43 patients) and refractory anemia with excess blasts-1 (MDS RAEB-1, 11/43 patients) subtypes. Nineteen males and 24 females were analyzed, with Dm age 73(55–85)
P. Boulanger1 , T. Comont2 , J. Moeglin2 , M.-F. Thiercelin-Legrand1 , 3 P. Cougoul2 , C. Recher ´ , O. Beyne-Rauzy2 . 1 Home Services, Sant´e 2 Relais 31, Internal Medicine, 3 Hematology, Purpan Universitary Hospital, Toulouse, France Background: Transfusion-dependence is a common issue in myelodysplastic syndromes (MDS) including low risk MDS after EPO failure or supportive care in high risk MDS. Purpose: Red blood cells (RBC) transfusions are usually performed at hospital. Alternative solutions are available through the development of home blood transfusion services in collaboration with the general practitioner [1,2]. We report our experience of home blood transfusions in MDS patients. Patients and Methods: Since 2009 our hospital developed home blood transfusion services. More than 220 red blood cell transfusions were made at home. We studied indications, safety, cost and feasibility of this modality of transfusion in comparison with standard procedure i.e. in hospitalization. Results: 116 transfusions were made in 25 patients. Mean age was 78.6 years (53–96). 16/25 patients (64%) suffered from myelodysplastic syndromes (MDS) or secondary acute myeloid leukemia (AML). Patients experienced no major adverse. In 10 cases transfusion was not possible due to nurse or general practitioner inaccessibility. No patient refused this modality of transfusion. Economic costs were evaluated: home transfusion appeared to be less expansive. Conclusion: home transfusion is safe and feasible. To receive treatment at home is a common patient’s preference and increase quality of life particularly in chronic disease which affects elderly people. Home supportive care represent an alternative solution if both patient and general practitioner are agree, that could improve hospital accessibility for more severe procedures. Reference(s) [1] Remonnay R et al. Bull Cancer 2008;95:1039–45. [2] Ademokun A et al. Transfusion Medicine 2005;15:219–22.