RBC Transfusion Dependency Linked to Reduced Overall Survival in Higher-Risk MDS

Among patients with myelodysplastic syndromes (MDS), red blood cell transfusion dependency negatively affects overall survival (OS) in those with higher risk disease as defined by the Molecular International Prognostic Scoring System (IPSS-M). This is according to a research team’s study findings presented at the 66th American Society of Hematology Annual Meeting & Exposition in San Diego, California.

“Since therapeutic approaches are based on the initial risk assessment, including transfusion dependency status in this stratification can provide more accurate prognostic information that might potentially impact on the treatment strategy,” wrote lead author Elena Bechtold Javier, MD, of Bellvitge Biomedical Research Institute, Barcelona, Spain.

The researchers could not confirm from their study if in lower risk IPSS-M MDS there was such a relationship between transfusion dependency and OS. They noted that a larger study is necessary to validate their findings.

The cohort in the presented study comprised 214 patients with MDS or myelodysplastic chronic myelomonocytic leukemia from 13 centers. The patients had a mean age at diagnosis of 69 years, and 57.9% were men.

The researchers organized the patients into two categories of low- versus high-risk MDS: 29.9% of patients had “low-risk” disease, defined according to IPSS-M as very-low, low, or low-intermediate risk disease; and 70.1% had “high-risk” disease, defined as IPSS-M high-intermediate, high, or very-high risk disease.

Transfusion dependency, defined as receiving at least one red blood cell transfusion every eight weeks for four months, was present in 58.4% of the cohort. Dependency was present in 17.1% of patients in the study’s low-risk disease category and in 76% of patients in the high-risk disease category.

For the surviving patients in the cohort, the median follow-up was 19.4 months. The median OS in the low-risk MDS category was 10.4 years, and in the high-risk MDS category, median OS was 1.6 years (P<.001). Among transfusion-dependent patients, the median OS was 1.49 years, and among nondependent patients, it was not reached (P<.001).

In the low-risk MDS category, the researchers found no differences in OS between transfusion-dependent and nondependent patients. In the high-risk MDS category, transfusion-dependent patients had lower median OS than nondependent patients, at 1.31 years; median OS was not reached in the group of nondependent patients (P<.001).

Multivariate analysis the researchers performed showed that age at diagnosis, high-risk disease, and transfusion dependency at diagnosis were independent factors of shorter OS.

Reference

Bechtold Javier E, Pomares H, Castaño-Díez S, et al. Impact of transfusion dependency on patients diagnosed with myelodysplastic syndrome according to IPSS-M risk group. Abstract #1838. Presented at the 66th American Society of Hematology Annual Meeting and Exposition; December 7-10, 2024; San Diego, California.