Survey on Recommended Health Care for Adult Patients with Myelodysplastic Syndromes Identifies Areas for Improvement
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Participants
2.3. Survey Design
2.4. Data Collection
2.5. Data Processing and Evaluation
2.6. Data Representation and Statistics
3. Results
3.1. Diagnostic Evaluation
3.2. Risk-Stratification
3.3. Treatment
3.3.1. Supportive Care
3.3.2. Growth Factors
3.3.3. Disease-Modifying Treatment
3.3.4. Allogeneic Hematopoietic Stem Cell Transplantation
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Abbreviations
ATG | Anti-thymocyte globulin |
AML | Acute myeloid leukemia |
BM | Bone marrow |
CCUS | Clonal cytopenia of unknown significance |
CGH | Comparative Genomic Hybridization |
CHIP | Clonal hematopoiesis of indeterminate potential |
COS | Core outcome set |
CsA | Cyclosporin A |
DGHO | Deutsche Gesellschaft für Hämatologie und Onkologie |
DKG | Deutsche Krebs Gesellschaft |
EHA | European Hematology Association |
ELN | European Leukemia Net |
EPO | Erythropoietin |
ESA | Erythropoietin Stimulating Agents |
ESMO | European Society of Medical Oncology |
FISH | Fluorescent In-Situ Hybridisation |
GA | Geriatric assessment |
G-CSF | Granulocyte Colony-Stimulating Factor |
G/Rs | Guidelines and recommendations |
HCT-CI | Hematopoietic Cell Transplantation Comorbidity Index |
HI | Hematological improvement |
HMA | Hypomethylating agents |
HSCT | Hematopoietic stem cell transplantation |
ICUS | Idiopathic cytopenia of unknown significance |
IDUS | Idiopathic dysplasia of unknown significance |
IP | Immunophenotyping |
IPSS | International Prognostic Scoring System |
IPSS-R | Revised International Prognostic Scoring System |
IST | Immunosuppressive Treatment |
LEN | Lenalidomide |
MDS | Myelodysplastic syndromes |
PB | Peripheral blood |
SMSG | Swiss MDS Study Group |
SSH | Swiss Society of Hematology |
TPO-RA | Thrombopoietin receptor agonists |
QoL | Quality of life |
WHO | World Health Organisation |
WPSS | WHO Prognostic Scoring System |
References
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Total | 43 (100%) | |
---|---|---|
Age-categories | ||
30–40 years | 10 (23.2%) | |
41–50 years | 20 (46.5%) | |
51–60 years | 9 (20.9%) | |
61–70 years | 2 (4.7%) | |
Missing | 2 (4.7%) | |
Year of board certification | ||
1986–2000 | 7 (16.3%) | |
2001–2010 | 13 (30.2%) | |
2011–2017 | 16 (37.2%) | |
Missing | 7 (16.3%) | |
Institution | ||
General practice | 1 (2.3%) | |
Specialised practice | 5 (11.6%) | |
Primary center | 5 (11.6%) | |
Secondary center | 14 (32.6%) | |
Tertiary center | 18 (41.9%) | |
Missing | - | |
Medical association membership | ||
SSH | 36 (90%) | |
EHA | 25 (62.5%) | |
ASH | 13 (30%) | |
SMSG | 7 (17.5%) | |
DGHO | 7 (17.5%) | |
SSMO | 4 (10%) | |
Missing | 3 (7%) | |
Agreement with ELN 2013 recommendations for diagnosis of MDS(1) | Yes | 38 (88.3%) |
No | 2 (4.7%) | |
Not familiar | 3 (7%) | |
Agreement with ELN 2013 recommendations for treatment of MDS(1) | Yes | 37 (86%) |
No | 2 (4.7%) | |
Not familiar | 3 (7%) | |
Missing | 1 (2.3%) |
Questions | Feedback | Performance |
---|---|---|
1. Classification | ||
MDS classification system | 43 (100%) | WHO 2016 ([23]): 41 (95.3%) WHO 2008 ([26]): 12 (27.9%) FAB ([27]): 3 (7%) |
Use of the diagnostic terms ICUS, IDUS, CCUS or CHIP [24] | 43 (100%) | Yes: 29 (67.4%) No: 14 (32.6%) |
2. Bone Marrow (BM) | ||
Time of the BM assessment | 43 (100%) | At (suspected) diagnosis: 43 (100.0%) At (suspected) progression: 40 (93.0%) To access response to hypomethylating agents (HMAs): 20 (46.5%) |
Who evaluates BM smears at your institution? | 43 (100%) | Hematologist: 41 (95.3%) Pathologist: 10 (23.3%) |
Acceptable inter-observer variability of morphological signs of dysplasia | 43 (100%) | Yes: 24 (55.8%) No: 19 (44.2%) |
Does morphological quantification of blasts have an acceptable inter-observer variability? | 43 (100%) | Yes: 31 (72.1%) No: 12 (27.9%) |
3. Cytogenetics/FISH | ||
When should karyotyping be performed? | 43 (100%) | At (suspected) diagnosis: 43 (100.0%) At (suspected) progression: 35 (81.4%) To assess response to hypomethylating agents (HMAs): 9 (20.9%) |
Necessity of analysis with an MDS FISH panel in MDS patients with normal karyotype | 43 (100%) | Yes: 21 (48.8%) No: 15 (34.9%) Undecided: 7 (16.3%) |
Should array-CGH replace MDS FISH panels in MDS patients with normal karyotype? | 43 (100%) | Yes: 17 (39.5%) Undecided: 14 (32.6%) No: 12 (27.9%) |
4. Molecular Diagnostics | ||
Do you use molecular diagnostics for MDS? | 43 (100%) | Yes: 37 (86.0%) No: 6 (14.0%) |
What type of gene panel do you use for diagnosis? | 37 (86%) | Comprehensive myeloid driver gene panel (>10 genes): 29 (78.4%) Undecided: 5 (13.5%) Only single gene analysis: 3 (8.1%) Reduced myeloid driver gene panel: 0 (0.0%) |
5. Flow Cytometry | ||
Do you use flow cytometry for MDS diagnosis? | 43 (100%) | Yes: 28 (65.1%) No: 15 (34.9%) |
Do you use the OGATA flow cytometry score for MDS diagnosis [28]? | 28 (65.1%) | Yes: 18 (64.3%) I am not familiar with OGATA flow score: 5 (17.9%) No: 4 (14.3%) I am using another flow score: 1 (3.6%) |
6. Germ Line Predisposition | ||
Are you aware of hereditary AML/MDS syndromes? | 43 (100%) | Yes: 33 (76.7%) No: 10 (23.3%) |
Do you record a pedigree for patients with suspected hereditary AML/MDS syndromes? | 33 (76.7%) | Yes: 23 (69.7%) No: 10 (30.3%) |
Do you use a questionnaire for the screening of patients with suspected hereditary AML/MDS syndromes [25]? | 33 (76.7%) | No: 31 (93.9%) Yes: 2 (6.1%) |
Have you ever referred a patient to genetic counseling due to suspected hereditary AML/MDS syndrome? | 33 (76.7%) | No: 26 (78.8%) Yes: 7 (21.2%) |
Questions | Feedback | Performance |
---|---|---|
Should assessment of disease- and patient-based risk factors be performed? | 42 (97.7%) | Yes: 40 (95.2%) Undecided: 2 (4.8%) No: 0 (0.0%) |
1. Disease-Based Risk-Stratification | ||
When do you use disease-based risk-stratification scores in MDS patients? | 42 (97.7%) | At diagnosis: 41 (97.6%) At progression: 31 (73.8%) At transplantation: 24 (57.1%) Other time points: 1 (2.4%) Not at all: 0 (0.0%) |
Which of the following scores do you use for disease-based risk-stratification? | 42 (97.7%) | R-IPSS/IPSS-R [29]: 41 (97.6%) IPSS [30]: 28 (66.7%) WPSS [31]: 19 (45.2%) Other: 0 (0.0%) |
2. Patient-Based Risk-Stratification | ||
Do you use patient-based risk-stratification scores in all MDS patients? | 42 (97.7%) | Yes: 23 (54.8%) No: 19 (45.2%) |
When do you use patient-based risk-stratification scores in MDS patients? | 23 (53.5%) | At diagnosis: 18 (78.3%) At transplantation: 17 (73.9%) At progression: 13 (56.5%) Other time points: 1 (4.3%) Not at all: 1 (4.3%) |
Which of the following scores do you use for patient-based risk-stratification? | 39 (90.7%) | HCT-CI (Hematopoietic Cell Transplantation-specific comorbidity index) [32]: 26 (66.7%) MDS-CI (MDS comorbidity index) [33]: 14 (35.9%) CCI (Charlson comorbidity index) [34]: 12 (30.8%) Other: 5 (12.8%) |
3. Others | ||
Do you use the prognostic model for hypoplastic MDS [35]? | 39 (90.7%) | I am not familiar: 15 (38.5%) Yes: 13 (33.3%) No: 11 (28.2%) |
Do you use a combined risk-stratification tool? | 42 (97.7%) | No: 39 (92.9%) Yes: 3 (7.1%) |
Do you use geriatric assessment tools to decide, if elderly high-risk MDS patients with excess of blasts are eligible for standard induction chemotherapy? | 42 (97.7%) | No: 30 (71.4%) Yes: 12 (28.6%) |
Do you use quality of life (QoL) assessment tools? | 42 (97.7%) | No: 37 (88.1%) Yes: 5 (11.9%) |
Questions | Feedback | Performance |
---|---|---|
1. RBC and TC Transfusions | ||
Hemoglobin threshold for RBC transfusion for younger patients (<70 years) without comorbidities? | 41 (95.3%) | Only if symptomatic: 4 (9.8%) < 60 g/L: 10 (24.4%) < 70 g/L: 17 (41.5%) < 80 g/L 8 (19.5%) < 90 g/L: 1 (2.4%) < 100 g/L: 0 (0.0%) Other: 1 (2.4%) |
Hemoglobin threshold for RBC transfusion for younger patients (<70 years) with relevant cardiovascular or pulmonary comorbidities? | 41 (95.3%) | Only if symptomatic: 2 (4.9%) < 60 g/L: 0 (0.0%) < 70 g/L: 13 (31.7%) < 80 g/L: 19 (46.3%) < 90 g/L: 4 (9.8%) < 100 g/L: 1 (2.4%) Other: 2 (4.9%) |
Hemoglobin threshold for RBC transfusion for elderly patients (≥70 years) without comorbidities? | 41 (95.3%) | Only if symptomatic: 3 (7.3%) < 60 g/L: 0 (0.0%) < 70 g/L: 16 (39.0%) < 80 g/L: 18 (43.9%) < 90 g/L: 3 (7.3%) < 100 g/L: 0 (0.0%) Other: 1 (2.4%) |
Hemoglobin threshold for RBC transfusion for elderly patients (≥70 years) with relevant cardiovascular or pulmonary comorbidities? | 41 (95.3%) | Only if symptomatic: 1 (2.4%) < 60 g/L: 0 (0.0%) < 70 g/L: 2 (4.9%) < 80 g/L: 16 (39.0%) < 90 g/L: 14 (34.1%) < 100 g/L: 6 (14.6%) Other: 2 (4.9%) |
Platelet threshold for transfusion for younger patients (<70 years) without signs of bleeding or infection? | 41 (95.3%) | Only in case of clinically relevant bleeding: 8 (19.5%) < 5 G/L: 8 (19.5%) < 10 G/L: 24 (58.5%) < 20 G/L: 0 (0.0%) < 30 G/L: 0 (0.0%) Other: 1 (2.4%) |
Platelet threshold for transfusion for elderly patients (≥70 years) without signs of bleeding or infection? | 41 (95.3%) | Only in case of clinically relevant bleeding: 7 (17.1%) < 5 G/L: 8 (19.5%) < 10 G/L: 25 (61.0%) < 20 G/L: 1 (2.4%) < 30 G/L: 0 (0.0%) Other: 0 (0.0%) |
Platelet threshold for patients with signs of infection? | 41 (95.3%) | Only in case of clinically relevant bleeding: 1 (2.4%) < 5 G/L: 0 (0.0%) < 10 G/L: 20 (48.8%) < 20 G/L: 19 (46.3%) < 30 G/L: 1 (2.4%) Other: 0 (0.0%) |
2. Infection Prophylaxis | ||
Do you provide empirical infection prophylaxis in patients with severe neutropenia (<0.5 G/L)? | 41 (95.3%) | No: 26 (63.4%) Yes: 11 (26.8%) Only after previous infection: 4 (9.8%) |
Questions | Feedback | Performance |
---|---|---|
1. Erythropoietin Stimulating Agents (ESA) | ||
Do you agree with the ELN 2013 recommendations for ESA treatment in MDS patients [1]? | 41 (95.3%) | Yes: 34 (82.9%) I am not familiar: 4 (9.8%) No: 3 (7.3%) |
Which ESA do you prefer? | 41 (95.3%) | Darbepoetin alfa (Aranesp®): 31 (75.6%) No preference: 5 (12.2%) Epoetin alfa (e.g., Eprex®): 3 (7.3%) Epoetin beta (e.g., Recormon®): 2 (4.9%) |
What is the Hemoglobin concentration you aim for (g/L)? | 41 (95.3%) | 80–89: 6 (14.6%) 90–99: 7 (17.1%) 100–109: 21 (51.2%) 110–119: 7 (17.1%) ≥120: 0 (0.0%) |
After what time do you adapt the initial dose (weeks)? | 40 (93%) | 0: 2 (5%) 2: 5 (12.5%) 4: 15 (37.5%) 6: 10 (25%) 8: 7 (17.5%) 10: 0 (0.0%) 12: 1 (2.5%) |
What is the maximum dose you use in order to test ESA responsiveness for epoetin beta? | 15 (total response: 35, 81.4%) | 10,000: 1 (6.6%) 30,000: 4 (26.7%) 40,000: 1 (6.6%) 60,000: 4 (26.7%) 80,000: 4 (26.8%) 100,000: 1 (6.6%) |
What is the maximum dose you use in order to test ESA responsiveness for darbepoetin alfa? | 20 (total response: 35, 81.4%) | 150: 1 (5%) 250: 1 (5%) 300: 2 (10%) 500: 16 (80%) |
Do you add G-CSF in non-responders? | 41 (95.3%) | No: 31 (75.6%) Yes: 10 (24.4%) |
Do you try lenalidomide in non-responders? | 40 (93%) | Only in del(5q): 22 (55%) Yes: 12 (30%) No: 6 (15%) |
2. Granulocyte-Colony-Stimulating Factor (G-CSF) | ||
Do you use G-CSF for primary infection prophylaxis in neutropenic patients? | 41 (95.3%) | No: 37 (90.2%) Yes: 4 (9.8%) |
Do you use G-CSF for secondary infection prophylaxis in neutropenic patients that experienced neutropenic fever? | 41 (95.3%) | Yes: 25 (61%) No: 16 (39%) |
What is your neutrophil trigger for secondary infection prophylaxis? | 25 (58.1%) | <1.5 G/L: 0 (0.0%) <1.0 G/L: 2 (8%) <0.5 G/L: 22 (88%) <0.2 G/L: 1 (4%) |
Do you use pegylated G-CSF? | 26 (60.5%) | No: 16 (61.5%) Yes: 10 (38.5%) |
3. Thrombopoietin-Receptor Agonist (TPO-RA) | ||
Do you use TPO-RA in thrombopenic MDS patients? (multiple answers possible) | 40 (93%) | In MDS with concomitant ITP: 18 (45%) In hypoplastic MDS: 15 (37.5%) Not at all: 13 (32.5%) In lower-risk MDS (IPSS low, int-1): 12 (30%) As secondary bleeding prophylaxis: 6 (15%) In higher-risk MDS (IPSS int-2, high): 2 (5%) As primary bleeding prophylaxis: 1 (2.5%) |
Which TPO-RA do you prefer? | 26 (60.5%) | I do not have a preference: 11 (42.3%) Romiplostim (Nplate®): 8 (30.8%) Eltrombopag (Revolade®): 7 (26.9%) |
Which platelet count trigger do you use for secondary TPO-RA treatment (G/L)? | 27 (62.8%) | 20: 11 (40.7%) 10: 9 (33.3%) 30: 6 (22.2%) 5: 1 (3.7%) 50: 0 (0.0%) |
Which maximum dose do you use for eltrombopag? | 18 (total response: 27, 62.8%) | 100 mg (50 mg asian)/day: 7 (25.9%) 200 mg (100 mg asian)/day: 6 (22.2%) 300 mg (150 mg asian)/day: 5 (18.5%) |
Which maximum dose do you use for romiplostim? | 19 (total response: 27, 62.8%) | 10 ug/kg/week: 14 (51.9%) 5 ug/kg/week: 2 (7.4%) Other: 3 (11.1%) |
Questions | Feedback | Performance |
---|---|---|
1. Lenalidomid (LEN) | ||
Do you use LEN in del(5q) MDS patients? | 40 (93%) | Yes: 39 (97.5%) No: 1 (2.5%) |
Which initial LEN dose do you use in MDS patients? | 38 (88.4%) | 10 mg d1–21: 26 (68.4%) 10 mg d1–28: 7 (18.4%) 5 mg d1–21: 2 (5.3%) 5 mg d1–28: 2 (5.3%) Other dose: 1 (2.6%) |
Do you assess EPO responsiveness before LEN? | 38 (88.4%) | Yes: 25 (65.8%) No: 13 (34.2%) |
Do you combine LEN and EPO? | 38 (88.4%) | No: 28 (73.7%) Yes: 10 (26.3%) |
Do you use LEN in del(5q) with additional cytogenetic alterations (except alterations of chromosome 7)? | 38 (88.4%) | Yes: 29 (76.3%) No: 9 (23.7%) |
How many cytogenetic alterations would you accept beside del(5q) to treat with LEN? | 29 (67.4%) | 1 additional alteration: 12 (41.4%) 2 additional alterations: 8 (27.6%) 3 additional alterations: 2 (6.9%) More than 3 additional alterations: 7 (24.1%) |
Do you check TP53 mutational status before prescribing LEN? | 38 (88.4%) | Yes: 25 (65.8%) No: 13 (34.2%) |
Do you check TP53 mutational status in non-responders to LEN? | 38 (88.4%) | Yes: 24 (63.2%) No: 14 (36.8%) |
Do you use LEN in non-del(5q) MDS patients? | 39 (90.7%) | No: 26 (66.7%) Yes: 13 (33.3%) |
Do you provide thromboembolic prophylaxis when prescribing LEN? | 39 (90.7%) | No: 28 (71.8%) Yes: 11 (28.2%) |
2. Immunosuppressive Treatment (IST) | ||
Do you treat patient with hypoplastic MDS with ATG/CsA? | 39 (90.7%) | Yes: 28 (71.8%) No: 11 (28.2%) |
Do you try ATG/CsA in MDS patients with other than hypoplastic MDS? | 39 (90.7%) | No: 37 (94.9%) Yes: 2 (5.1%) |
Is ATG/CsA your first choice in younger patients (<40 years) with hypoplastic MDS? | 28 (65.1%) | Yes: 15 (53.6%) No: 13 (46.4%) |
Do you always combine CsA with ATG in elderly patients (>70 years) with hypoplastic MDS? | 28 (65.1%) | No: 20 (71.4%) Yes: 8 (28.6%) |
Do you use steroids in MDS patients? | 39 (90.7%) | No: 25 (64.1%) Yes: 14 (35.9%) |
3. Hypomethylating Agents (HMA) | ||
What minimal risk category do you require for treatment with HMA? | 39 (90.7%) | Intermediate (IPSS: Int-1; IPSS-R: Intermediate): 25 (64.1%) High (IPSS: Int-2, high; IPSS-R: high, very high): 11 (28.2%) IPSS score does not influence my decision for HMA: 3 (7.7%) Low (IPSS: Low; IPSS-R: Very Low & Low): 0 (0.0%) |
Are severe thrombopenia (<20 G/L), anemia (<70 g/L) or neutropenia (<0.5 G/L) an indication for treatment irrespective of IPSS or IPSS-R? | 39 (90.7%) | Yes: 25 (64.1%) No: 14 (35.9%) |
Which HMA do you preferably use for MDS patients? | 39 (90.7%) | 5-Azacytidine (AZA, Vidaza®): 38 (97.4%) Decitabine (DEC, Dacogen®): 1 (2.6%) |
What is the standard dose you use for 5-Azacytidine (AZA)? | 38 (88.4%) | 100 mg/m2 d1–d5: 24 (63.2%) 75 mg/m2 d1–d7: 14 (36.8%) Other: 0 (0.0%) |
Do you reduce the dose in frail patients with non-high-risk MDS? | 39 (90.7%) | No: 22 (56.4%) Yes: 17 (43.6%) |
Do you reduce the dose in frail patients with high-risk MDS? | 39 (90.7%) | No: 30 (76.9%) Yes: 9 (23.1%) |
To which extent do you reduce the dose of HMA in frail MDS patients? | 37 (86%) | 75% of standard dose: 14 (37.8%) 50% of standard dose: 6 (16.2%) 25% of standard dose: 6 (16.2%) Other dose reduction: 11 (29.7%) |
Do you perform BM aspiration in MDS patients under HMA therapy at best response? | 39 (90.7%) | Not on a regular basis: 23 (59%) Yes: 8 (20.5%) No: 8 (20.5%) |
Do you perform BM aspiration in MDS patients under HMA therapy in stable patients after 4–6 cycles? | 39 (90.7%) | Not on a regular basis: 19 (48.7%) Yes: 14 (35.9%) No: 6 (15.4%) |
Do you perform BM aspiration in MDS patients under HMA therapy at progression? | 39 (90.7%) | Yes: 35 (89.7%) Not on a regular basis: 4 (10.3%) No: 0 (0.0%) |
Do you reduce the dose of HMA in responding patients after 6 cycles? | 39 (90.7%) | No: 24 (61.5%) Only in patients with side effects: 16 (41%) Yes: 1 (2.6%) |
Do you extend the interval of HMA application in responding patients? | 39 (90.7%) | No: 17 (43.6%) Yes: 9 (23.1%) Only in patients with side effects: 13 (33.3%) |
Do you think that stable disease after 6 cycles in high-risk MDS patients can be considered as response? | 39 (90.7%) | Yes: 26 (66.7%) No: 13 (33.3%) |
Questions | Feedback | Performance |
---|---|---|
Do you perform allo HSCT at your center? | 40 (93%) | Yes: 6 (15%) No: 34 (85%) |
1. Indications | ||
At what risk category do you envisage allo HSCT? | 6 (100%) | High (IPSS: Int-2, high; IPSS-R: high, very high): 5 (83.3%) Intermediate (IPSS: Int-1; IPSS-R: Intermediate): 1 (16.7%) Low (IPSS: Low; IPSS-R: Very Low & Low): 0 (0.0%) IPSS score does not influence my decision for allo HSCT: 0 (0.0%) |
What is the maximum age to envisage allo HSCT? | 6 (100%) | 65–69 years: 1 (16.7%) 70–74 years: 5 (83.3%) >75 years: 0 (0.0%) |
Which HCT-CI/MDS-CI score precludes allo HSCT? | 6 (100%) | HCT-CI/MDS-CI ≥3 (less fit): 4 (66.7%) HCT-CI/MDS-CI 1-2 (intermediate fit): 2 (33.3%) HCT-CI/MDS-CI 0 (fit): 0 (0.0%) |
2. Induction Therapy | ||
What is your preferred induction therapy for fit MDS patients (HCT-CI/MDS-CI: 0) with <5% BM-blasts eligible for allo HSCT? | 6 (100%) | HMA: 3 (50.0%) No induction, upfront allo HSCT: 2 (33.3%) Standard AML induction chemotherapy (e.g., 3 + 7): 1 (16.7%) Other: 0 (0.0%) |
What is your preferred induction therapy for fit MDS patients (HCT-CI/MDS-CI: 0) with >5% BM-blasts eligible for allo HSCT? | 6 (100%) | Standard AML induction chemotherapy (e.g., 3 + 7): 5 (83.3%) HMA: 1 (16.7%) No induction, upfront allo HSCT: 0 (0.0%) Other: 0 (0.0%) |
What is your preferred induction therapy for intermediate fit MDS patients (HCT-CI/MDS-CI: 1–2) with <5% BM-blasts eligible for allo HSCT? | 6 (100%) | HMA: 3 (50.0%) No induction, upfront allo HSCT: 3 (50.0%) Standard AML induction chemotherapy (e.g., 3 + 7): 0 (0.0%) Other: 0 (0.0%) |
What is your preferred induction therapy for intermediate fit MDS patients (HCT-CI/MDS-CI: 1-2) with >5% BM-blasts eligible for allo HSCT? | 6 (100%) | HMA: 4 (66.7%) Standard AML induction chemotherapy (e.g., 3 + 7): 2 (33.3%) No induction, upfront allo HSCT: 0 (0.0%) Other: 0 (0.0%) |
3. Conditioning Therapy | ||
What is your preferred conditioning strategy for fit MDS patients (HCT-CI/MDS-CI: 0) with <5% BM-blasts eligible for allo HSCT? | 6 (100%) | RIC: 3 (50.0%) MAC: 3 (50.0%) |
What is your preferred conditioning strategy for fit MDS patients (HCT-CI/MDS-CI: 0) with >5% BM-blasts eligible for allo HSCT? | 6 (100%) | RIC: 3 (50.0%) MAC: 3 (50.0%) |
What is your preferred conditioning strategy for intermediate fit MDS patients (HCT-CI/MDS-CI: 1–2) with <5% BM-blasts eligible for allo HSCT? | 6 (100%) | RIC: 6 (100.0%) MAC: 0 (0.0%) |
What is your preferred conditioning strategy for intermediate fit MDS patients (HCT-CI/MDS-CI: 1–2) with >5% BM-blasts eligible for allo HSCT? | 6 (100%) | RIC: 5 (83.3%) MAC: 1 (16.7%) |
4. Others | ||
Do you perform autologous HSCT as a consolidation therapy for MDS patients without a suitable donor? | 6 (100%) | No: 6 (100%) Yes: 0 (0.0%) |
Do you consider molecular risk factors such as TP53 or RAS for the decision to transplant or not? | 6 (100%) | Yes: 5 (83.3%) No: 1 (16.7%) |
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Chanias, I.; Wilk, C.M.; Benz, R.; Daskalakis, M.; Stüssi, G.; Schmidt, A.; Bacher, U.; Bonadies, N.; on behalf of the Swiss MDS Study Group. Survey on Recommended Health Care for Adult Patients with Myelodysplastic Syndromes Identifies Areas for Improvement. Int. J. Environ. Res. Public Health 2020, 17, 9562. https://doi.org/10.3390/ijerph17249562
Chanias I, Wilk CM, Benz R, Daskalakis M, Stüssi G, Schmidt A, Bacher U, Bonadies N, on behalf of the Swiss MDS Study Group. Survey on Recommended Health Care for Adult Patients with Myelodysplastic Syndromes Identifies Areas for Improvement. International Journal of Environmental Research and Public Health. 2020; 17(24):9562. https://doi.org/10.3390/ijerph17249562
Chicago/Turabian StyleChanias, Ioannis, C. Matthias Wilk, Rudolf Benz, Michael Daskalakis, Georg Stüssi, Adrian Schmidt, Ulrike Bacher, Nicolas Bonadies, and on behalf of the Swiss MDS Study Group. 2020. "Survey on Recommended Health Care for Adult Patients with Myelodysplastic Syndromes Identifies Areas for Improvement" International Journal of Environmental Research and Public Health 17, no. 24: 9562. https://doi.org/10.3390/ijerph17249562