Survival and quality of life in patients with lower-risk myelodysplastic syndromes exposed to erythropoiesis-stimulating agents: an observational cohort study
The EUMDS study group presents a paper in the February 2025 issue of Lancet Haematology. It is a longitudinal observational cohort study from The European MDS Registry, with 2448 patients from Jan 1st, 2008, to Jan 1st, 2019, with lower-risk myelodysplastic syndrome/neoplasm (MDS), a chronic myeloid malignancy characterized by long-lasting anemia significantly affecting the clinical outcome and the quality of life. The cohort was separated into patients not exposed to erythropoiesis-stimulating agents (ESA) (the ESA-unexposed group [n=1265]), and patients exposed to ESA (the ESA-exposed group [n=1183]). The effect of ESA treatment on overall survival as well as general Health Related Quality of life (HRQoL) was evaluated. Whether or not a patient had received red blood cell transfusion (RBCT) was also considered in the analyses.
The study compared patients exposed to ESA (N= 744) to ESA-unexposed patients (N=426) using statistical methods for observational data (propensity method). Patients in the ESA-exposed group had an median overall survival advantage of 10.1 months compared to the ESA-unexposed group (respectively 44·9 versus 34·8 months; p<0·0001). Patients without RBCT in the presence or absence of ESA exposure maintained significantly better HRQoL than those with RBCT, irrespective of ESA exposure (p<0·0001). The efficacy of ESA was better when initiated before or early after the onset of a permanent transfusion need.
This is an important study showing that ESA treatment has a significant effect on survival, and that it is important to start ESA before RBCT, if possible, to yield the best effect of ESA. Avoiding RBCT is associated with significantly better HRQoL.
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