The impact of age on the diagnosis and therapy of myelodysplastic syndromes: results from a retrospective multicenter analysis in Germany

Myelodysplastic syndromes (MDS) is a disease of predominantly elderly patients with a median age of >70yrs. However, data on the management of these patients outside of clinical trials are scarce. To assess patterns of MDS management in routine patient care with regard to the impact of age, we conducted a multicenter, representative survey of MDS health services in Germany. Data of 269 patients treated at 57 institutions were collected from preplanned chart reviews and were analyzed retrospectively. At diagnosis, median age was 70yrs, 50% of patients had a Karnofsky index (KI) of 90%, and 12% had a comorbidity index3 according to Sorror etal. (J Clin Oncol, 25, 2007, 4246). Cytogenetic analysis and International Prognostic Scoring System (IPSS) risk assessment were performed significantly less frequently in patients >75yrs than in patients 75yrs (P<0.001 and P=0.019). In bivariate analysis, potential predictors for performing IPSS risk assessment were age 75yrs (y/n, P=0.019), diagnosis at a university hospital (y/n, P=0.001), WHO subtypes RCUD (y/n, P=0.028), RARS (y/n, P=0.002), or RAEB II (y/n, P=0.037). Patients 75yrs were more likely to receive active therapies (i.e., chemotherapy, immunomodulatory therapy, or epigenetic therapy) than patients >75yrs (51% vs. 37%, P=0.007). In bivariate analysis age 75yrs (y/n, P=0.007) was a significant predictor for active treatment with no correlation with the other predictors [IPSS risk score int-2 or high (y/n, P=0.005), WHO subtypes RCUD (y/n, P<0.001), RCMD (y/n, P=0.003), RAEB II (y/n, P<0.001), or CMML I (y/n, P=0.020)]. This survey confirms the impact of age on the thoroughness of MDS diagnosis and the decision for active treatment. As cytogenetic analysis and risk assessment are essential for the choice of appropriate therapy, elderly patients in particular may not be receiving adequate treatment.