SMD PRESENTATION - longue vie et autonomie (HEGP)
SMD PRESENTATION - longue vie et autonomie (HEGP)
SMD PRESENTATION - longue vie et autonomie (HEGP)
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DIU ONCOGERIATRIE Universités Paris 5 & 6 Année 2008<br />
<strong>SMD</strong> : Epo sérum / Hémoglobine<br />
Patients<br />
Total population n=419<br />
GFM prospective trials<br />
epoi<strong>et</strong>in alfa+ filgrastim<br />
Darbepoi<strong>et</strong>in+/- G-CSF<br />
epoi<strong>et</strong>in b<strong>et</strong>a+ ATRA (EPO arm)<br />
n=133<br />
30<br />
62<br />
41<br />
JACOBS A, BJH, 1989<br />
Patients<br />
Patients<br />
• Inclusion criteria: MDS, WHO classification in 25 GFM<br />
centers<br />
WHO classification<br />
RA<br />
%<br />
14<br />
N<br />
61<br />
• Treatment b<strong>et</strong>ween 1998 and 2006:<br />
– epoi<strong>et</strong>in alpha <strong>et</strong> b<strong>et</strong>a (Eprex, OrthoBiotech/ Neorecormon, Roche)<br />
20000 UI X 3 /week<br />
– darbepoi<strong>et</strong>in alfa (Aranesp, Amgen) 300µg/week<br />
RARS<br />
RAEB-1<br />
RAEB-2<br />
RCMD<br />
19<br />
21<br />
6<br />
16<br />
83<br />
92<br />
26<br />
68<br />
– G-CSF (filgrastim, Amgen; lenograstim, Chugai)<br />
RCMD-RS<br />
13<br />
58<br />
• Evaluation of response to EPO at week 12 with IWG 2000<br />
and IWG 2006 criteria<br />
5q- syndrome<br />
unclassified<br />
4<br />
3<br />
17<br />
14<br />
Patients characteristics<br />
Response<br />
(IWG 2000 and IWG 2006)<br />
EPO level (UI/l, median, range)<br />
>500 (n=, % of patients)<br />
200<br />
na<br />
Transfused (n ,% of patients )<br />
Treatment<br />
EPO alfa<br />
EPO b<strong>et</strong>a<br />
EPO+G-CSF<br />
DAR<br />
DAR+G-CSF<br />
76 (6-5665)<br />
29 (7%)<br />
256 (61%)<br />
94 (22%)<br />
69 (17%)<br />
227 (54%)<br />
53<br />
122<br />
80<br />
126<br />
28<br />
Response<br />
(IWG 2000)<br />
Major<br />
Minor<br />
Minor response=88<br />
(IWG 2000)<br />
262/419<br />
174<br />
88<br />
63%<br />
41%<br />
22%<br />
63% (n=56) = no response<br />
37% (n=32)= response<br />
Response rate (IWG 2006) 49% n=206<br />
IWG 2006<br />
10
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