Recombinant Erythropoietin in Myelodysplastic Syndromes: Whom to Treat and How? More Questions than Answers

1993 ◽  
Vol 90 (2) ◽  
pp. 53-57 ◽  
Author(s):  
Moshe Mittelman
Keyword(s):  
Myelodysplastic Syndromes ◽  
Recombinant Erythropoietin

scholarly journals Switching to an alternative recombinant erythropoietin agent in patients with myelodysplastic syndromes: a second honeymoon ?

2021 ◽  
Author(s):  
Bruno Fattizzo ◽  
Lorenzo Rizzo ◽  
Juri Alessandro Giannotta ◽  
Federico Mazzon ◽  
Nicola Cecchi ◽  
...  
Keyword(s):  
Myelodysplastic Syndromes ◽  
Recombinant Erythropoietin

scholarly journals THERAPY WITH HUMAN RECOMBINANT ERYTHROPOIETIN IN PATIENTS WITH MYELODYSPLASTIC SYNDROMES

1992 ◽  
Vol 81 (4) ◽  
pp. 628-630 ◽  
Author(s):  
Monica Razzano ◽  
Corrado Caslini ◽  
Sergio Cortelazzo ◽  
Vittorio Battistel ◽  
Alessandro Rambaldi ◽  
...  
Keyword(s):  
Myelodysplastic Syndromes ◽  
Recombinant Erythropoietin ◽  
Human Recombinant Erythropoietin

The Costs of Drugs Used to Treat Myelodysplastic Syndromes Following National Comprehensive Cancer Network Guidelines

2008 ◽  
Vol 6 (9) ◽  
pp. 942-953 ◽  
Author(s):  
Peter L. Greenberg ◽  
Leon E. Cosler ◽  
Salvatore A. Ferro ◽  
Gary H. Lyman
Keyword(s):  
National Comprehensive Cancer Network ◽  
Myelodysplastic Syndromes ◽  
Iron Chelation ◽  
International Prognostic Scoring System ◽  
Limited Attention ◽  
Recombinant Erythropoietin ◽  
Nccn Guidelines ◽  
Transfusion Requirements ◽  
Average Annual Cost ◽  
Cancer Network

Guidelines for management of patients with myelodysplastic syndromes (MDS) have been generated by the National Comprehensive Cancer Network (NCCN) Myelodysplastic Syndromes Panel. Because MDS is a heterogeneous spectrum of disorders, these patients have been categorized into prognostic subgroups, predominantly using the International Prognostic Scoring System (IPSS). Several drugs have been used to treat these patients, and their selection and sequential recommended use by the panel depend on disease characteristics and responses to treatment. Recombinant erythropoietin alfa and darbepoetin alfa have been the mainstay of therapy for treating anemia associated with MDS. The FDA has recently approved several other drugs for treating MDS, including azacytidine and decitabine for all stages of disease, lenalidomide for low-risk anemic patients with del(5q) chromosomal abnormality, and deferasirox for treating iron overload. For iron chelation, deferoxamine is also used occasionally. Treatment with immunosuppressive therapy (antithymocyte globulin and cyclosporin) has been therapeutically beneficial for a subset of younger patients with MDS. Because the financial cost of these therapies are substantial and have received only limited attention, this article evaluates the costs of specific drugs and their sequential use in the lower-risk IPSS (low and intermediate-1) subgroups based on the NCCN guidelines. Results estimate an average annual cost for potentially anemia-altering drugs of $63,577 per patient, ranging from $26,000 to $95,000, depending on the specific therapies. In patients for whom the therapies fail, annual costs for iron chelation plus red blood cell transfusions are estimated to average $41,412. The economic impact of drug therapy should be weighed against the patient's potential for improvement in clinical outcomes, quality of life, and transfusion requirements.

Darbepoetin 500 mcg Q3W, Alone or in Combination with Peg-Filgrastim, in Low/Int1 IPSS Risk Myelodysplastic Syndromes Unresponsive to Recombinant Erythropoietin.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4606-4606
Author(s):  
Oreste Villani ◽  
Roberto Guariglia ◽  
Giuseppe Pietrantuono ◽  
Maria Carmen Martorelli ◽  
Fiorella D’Auria ◽  
...  
Keyword(s):  
Myelodysplastic Syndromes ◽  
Initial Response ◽  
Fixed Dose ◽  
Recombinant Erythropoietin ◽  
Erythroid Response ◽  
Transfusion Independence ◽  
History Of ◽  
Previously Treated ◽  
Wbc Count ◽  
Long Acting

Abstract Darbepoetin (DPO), a long acting erythropoiesis stimulating protein, is effective in inducing erythroid responses in 40–71% of anemic patients with myelodysplastic syndromes (MDS) when given at fixed doses of 150–300 mcg once-a-week. Of interest, some of these responses have been reported in MDS patients previously treated with (and occasionally unresponsive to) recombinant erythropoietin (r-EPO). We aimed to explore, on a compassionate basis, the effects of a higher DPO dose, administered with longer intervals, specifically in this last setting of patients. A single s.c. injection of DPO at the dose of 500 mcg s.c. was given every 3 weeks (Q3W) in fifteen anemic MDS patients, who had a history of an unsuccessful prior treatment with alpha or beta r-EPO (total weekly doses of r-EPO received: 30.000–80.000 U, for at least 8 weeks), both primary resistant or with loss of efficacy after an initial response. Informed consent was obtained in all cases. Nine patients were male, six female; mean age was 71 years (range 62–82). According to WHO classification, there were 5 RA, 3 RARS, 6 RCMD and 1 RCMD-RS. IPSS score was low in 6 patients and intermediate-1 in the remaining 9 subjects. Baseline Hb levels ranged from 6.2 to 9.1 g/dl, twelve patients being transfusion-dependent. All patients were treated with at least 3 DPO doses (nine weeks of therapy) and were evaluable for short term response and safety. No relevant adverse effect attributable to DPO was recorded. According to recently revised IWG criteria, three patients (20%) achieved an erythroid response. Transfusion-independence was obtained in one of two transfusion-dependent responders. All responses occurred after 2 doses of DPO in patients with baseline endogenous EPO below 200 miu/ml, two of whom previously treated with r-EPO 10.000 U s.c. t.i.w, while one had received 40.000 U s.c. b.i.w. Erythroid responses were maintained prolonging intervals between two DPO administrations up to 6 weeks. Based on the previously described possible synergism between r-EPO and myeloid growth-factors in MDS and to the concomitant presence of symptomatic neutropenia, five patients non-responding to DPO alone received Peg-filgrastim, a novel, pegylated form of granulocyte-colony stimulating factor (G-CSF) with prolonged terminal half-life, at the dose of 6 mg s.c. every 3 weeks, in combination with DPO, for an additional period of 9 weeks. The treatment was well tolerated, but no improvement in Hb levels or reduction in transfusional support was observed. A significant increase in peripheral blood WBC count occurred in all patients treated with Peg-filgrastim. In this preliminary experience, DPO given at the fixed dose of 500 mcg Q3W was effective in some anemic MDS patients considered unresponsive to r-EPO. However, it should be taken into account the fact that at least two of responders had probably previously received r-EPO at sub-optimal doses (less than 40.000 U per week). The adjunct of Peg-filgrastim in this setting of patients resulted in an improvement of neutropenia, without effects on Hb levels.

P138 Myelodysplastic syndromes patients treated with recombinant erythropoietin show improved immunological functions

2007 ◽  
Vol 31 ◽  
pp. S115
Author(s):  
S. Prutchi-Sagiv ◽  
N. Golishevski ◽  
H.S. Oster ◽  
E. Naparstek ◽  
D. Neumann ◽  
...  
Keyword(s):  
Myelodysplastic Syndromes ◽  
Recombinant Erythropoietin

P141 High dose darbepoetin Q3W, alone or in combination with peg-filgrastim, for myelodysplastic syndromes unresponsive to recombinant erythropoietin

2007 ◽  
Vol 31 ◽  
pp. S117 ◽  
Author(s):  
P. Musto ◽  
L. Campioni ◽  
R. Guariglia ◽  
G. Pietrantuono ◽  
O. Villani ◽  
...  
Keyword(s):  
Myelodysplastic Syndromes ◽  
High Dose ◽  
Recombinant Erythropoietin
Sign in / Sign up

Export Citation Format

Share Document