Cumbersome blood cancer treatment can be postponed

It's possible to postpone the introduction of blood transfusions for an average of 17 months for patients with the low-risk variant of MDS blood cancer, provided they are given erythropoiesis-stimulating agents (ESA), which stimulate the body to produce red blood cells, according to a dissertation at Sahlgrenska Academy, Sweden.

"Traditional treatment has not called for starting with ESA before the patient has a need for transfusions," says Hege Garelius, a Ph.D. in the Institute of Medicine at Sahlgrenska Academy, a senior consultant at Sahlgrenska University Hospital and active in the RCC Väst Regional Cancer Center.

"What we see in this study is that if you want the benefits of ESA drugs, they should be administered before the need for transfusions is a fact, starting when the blood values are reaching levels that are getting close to a transfusion need."

"Traditional treatment has not called for starting with ESA before the patient has a need for transfusions," says Hege Garelius, a Ph.D. in the Institute of Medicine at Sahlgrenska Academy. She is also a chief physician at Sahlgrenska University Hospital and active in the RCC Väst Regional Cancer Center. "What we see in this study is that if you want the benefits of ESA drugs, they should be administered before the need for transfusions is a fact."

MDS (myelodysplastic syndromes) is a form of blood cancer, leukemia, in which blood-forming stem cells are afflicted, leading to a lack of mature blood cells. The disease is divided into a high-risk and a low-risk group, depending on the likelihood that the patient will develop acute leukemia.

Reassessment may be needed

In the case of low-risk MDS, treatment usually is not initiated until the blood count reaches a critical value, something that might need to be reassessed according to this latest research. It shows that if patients are treated early with ESA, they can get by significantly longer without blood transfusions.

ESA medications are a group of drugs that stimulate the body's own ability to produce red blood cells. The study has examined the effects of ESA on 1,800 patients with low-risk MDS from 17 European countries.

Patients who were quickly treated with ESA received their first blood transfusion after an average of 23 months, compared with 6 months for patients who did not get access to ESA until after the first transfusion.

Better quality of life

Delaying blood transfusions for a longer time can lead to a great improvement in the quality of life for MDS patients, who often are elderly.

"They can avoid going to the hospital every other week or every three weeks, and they also avoid the side effects," says Hege. "Blood transfusions create a surplus of iron in the body that is stored in internal organs such as the heart and liver. The patients often become tired and weak."

In Sweden about 3,700 people become ill with some form of blood cancer every year. 350 cases involve MDS. Over a period of time, MDS patients can also develop another type of blood cancer, AML (acute myeloid leukemia), which is the focus of the three other studies in the dissertation.