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Recombinant human erythropoietin in very elderly patients with myelodysplastic syndromes: results from a retrospective study

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Abstract

Myelodysplastic syndromes (MDS) are common in elderly patients. Recombinant human erythro-poietin (rHuEPO) has been widely used to treat anemia in lower risk MDS patients, but few data are known about rHuEPO treatment in the very elderly patient group. In order to investigate the role of rHuEPO treatment in terms of response, overall survival (OS), and toxicity in a very elderly MDS patient group, 93 MDS patients treated with rHuEPO when aged ≥80 years were selected among MDS cases enrolled in a retrospective multicenter study by the cooperative group Gruppo Romano Mielodisplasie (GROM) from Jan 2002 to Dec 2010. At baseline, median age was 82.7 (range 80–99.1) with a median hemoglobin (Hb) level of 9 g/dl (range 6–10.8). The initial dose of rHuEPO was standard (epoetin alpha 40,000 IU/week or epoetin beta 30,000 IU/week) in 59 (63.4 %) pa-tients or high in 34 (36.6 %) (epoetin alpha 80,000 IU/week) patients. We observed an erythroid response (ER) in 59 (63.4 %) patients. No thrombotic event was reported. Independent predictive factors for ER were low transfusion requirement before treatment (p = 0.004), ferritin <200 ng/ml (p = 0.017), Hb >8 g/dl (p = 0.034), and a high-dose rHuEPO treatment (p = 0.032). Median OS from rHuEPO start was 49.3 months (95 % CI 27.5–68.4) in responders versus 30.6 months (95 % CI 7.3–53.8) in resistant patients (p = 0.185). In conclusion, rHuEPO treatment is safe and effective also in the very elderly MDS patients. However, further larger studies are warranted to evaluate if EPO treatment could be worthwhile in terms of quality of life and cost-efficacy in very old patients.

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Acknowledgments

The corresponding author would like to thank Edith Lahner for her help and statistical advice.

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Sant’Andrea Hospital, Hematology Unit, Faculty of Medicine and Psychology, Sapienza University, Via di Grottarossa 1035, 00189, Rome, Italy

    Caterina Tatarelli, Virginia Naso & Maria Antonietta Aloe Spiriti

  2. Sandro Pertini Hospital, Rome, Italy

    Anna Lina Piccioni

  3. Policlinico Tor Vergata University, Rome, Italy

    Luca Maurillo & Francesco Buccisano

  4. San Camillo Hospital, Rome, Italy

    Roberta Battistini & Stefano Mancini

  5. Istituto Nazionale Tumori Regina Elena, Rome, Italy

    Mariella D’Andrea

  6. Policlinico Gemelli Catholic University, Rome, Italy

    Marianna Criscuolo & Maria Teresa Voso

  7. Campus Biomedico University, Rome, Italy

    Carolina Nobile

  8. Nuovo Regina Margherita Hospital, Rome, Italy

    Nicoletta Villivà

  9. S. Eugenio Hospital, Rome, Italy

    Benedetta Neri

  10. San Giovanni Hospital, Rome, Italy

    Susanna Fenu

  11. Department of Biotechnology and Hematology, Sapienza University, Rome, Italy

    Massimo Breccia & Roberto Latagliata

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  1. Caterina Tatarelli
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  2. Anna Lina Piccioni
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  15. Maria Teresa Voso
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  16. Roberto Latagliata
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  17. Maria Antonietta Aloe Spiriti
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Correspondence to Caterina Tatarelli.

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Tatarelli, C., Piccioni, A.L., Maurillo, L. et al. Recombinant human erythropoietin in very elderly patients with myelodysplastic syndromes: results from a retrospective study. Ann Hematol 93, 1413–1420 (2014). https://doi.org/10.1007/s00277-014-2053-9

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  • DOI: https://doi.org/10.1007/s00277-014-2053-9

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