PB2084 ERYTHROPOIETIN IN LOW RISK MDS: DIFFICULT TO CONVINCE FOR SAFETY DUE TO AFFORDABILITY; AN EXPERIENCE FROM PAKISTAN
Authors: N. Anwar, A. Arshad, N. Fatima, S. Sharif, T. Shamsi
Journal: HemaSphere (2019)

Background: Myelodysplastic syndromes (MDS) represent a diverse group of hematopoietic stem cell disorders characterized by ineffective hematopoiesis, morphological dysplasia and tendency for leukemic transformation. MDS being considered a relatively uncommon disorder in our region is presumed to be an incurable disease with majority of patients conventionally being treated by blood product support only. Most of the patients are unable to receive standard treatment due to financial reservations and presumed to have worst outcomes. To achieve better outcome erythropoietin administration is one of the better option to raise hemoglobin levels and avoid transfusion. Therefore the study was planned to evaluate the outcomes of mds patients treated with erythropoietin versus pack cell transfusion. Aims: The aim of the study was to assess outcomes in mds patients given erythropoietin versus those who received pack cell transfusion. Methods It was an observational study conducted at National institute of blood diseases and bone marrow transplantation, Karachi from June 2010 to December 2018. Approval from institutional ethics committee was obtained prior to the study. Patients were risk stratified according to IPSS scoring and included low and intermediate‐1 risk MDS patients requiring red cell transfusion. Division in two groups was made i.e. those who received erythropoietin and those who received pack cell transfusion. Baseline investigations were done including complete blood counts,bone marrow biopsy and cytogenetics. Analysis of variables was done by using SPSS version 23.0. Results: Out of 177 MDS patients enrolled at our hospital,108 (61%) patients were offered erythropoietin. Only 26 (24%) chose to get treated by erythropoietin and rest 82 (76%) opted for pack red cell transfusion. The average erythropoietin dose administered per week was 30,000IU and mean blood transfusion was 2 units pack red cells per month. The mean hemoglobin (Hb) level at baseline of erythropoietin and transfusion group was 4.95 ± 1.48 mg/dl and 5.1 ± 1.27 mg/dl respectively. Outcome was evaluated, 16 (61.5%) patients in erythropoietin group and 36 (46.3%) in transfusion group were alive and 10 (38.4%) and 46 (57%) died respectively. Leukemic transformation was observed in 06 patients in transfusion group while in only 1 patient in erythropoietin group. The mean rise of hemoglobin in erythropoietin group was 4.95 ± 1.48 mg/dl to 9.2 ± 2.1 mg/dl while in transfusion group average 1gm/dl increment in hemoglobin level was observed after transfusion. Summary/Conclusion: Our findings are suggestive of the fact that erythropoietin has an influential impact on hemoglobin levels. However, limited number of patients chosen erythropoietin as their treatment considering it costly as compared to transfusion. Evidence by our statistics suggested that in our region cost of erythropoietin is same what comparable as that of transfusion which includes replacement donors, transfusion and day care expenditures. Moreover, hazards and potential risks associated with transfusion can also be minimized. Further studies with large sample size are needed to evaluate outcomes of treatment options in MDS.