Access to diagnostic and therapeutic tools for Myelodysplastic Syndromes in general practice: Survey among South-American Hematologists

CRISP, RENÉE; HUAMAN-GARAICOA, FUAD; VALLADARES, XIMENA; CHOQUE, JUAN; IASTREBNER, MARCELO; NAVARRO, JUAN; UNDURRAGA, M SOLEDAD; GRILLÉ, SOFÍA; ROYG, MERCEDES; VIDAL, GABRIELA; MALDONADO, BELLA; GUILLERMO, CECILIA; SALINAS VIEDMA, VICTOR; BELLI, CAROLINA

Valencia

Simposio; 14th Symposium on Myelodysplastic Syndromes; 2017

Myelodysplastic Foundation

Myelodysplastic syndrome refers to a heterogeneous group of closely related clonal hematopoietic disorders. Among the diagnostic and prognostic tools, pathology, cytogenetics, immunophenotyping and more recently point mutations have been shown to identify patients at different risk for survival. Standard treatment options include supportive care, disease-modifying agents and allogeneic hematopoietic stem cell transplantation (HSCT). To assess the real-world practice patterns within Latin-America (LA), we decided to conduct this study. Since August 2015, a printed 23-question survey was collected from hematologists in LA. Among the 425 respondents, 234 were from Argentine, 8 from Bolivia, 47 from Chile, 36 from Ecuador, 10 from Paraguay, 64 from Peru and 26 from Uruguay yielding a varying response rate of 22-90% depending on their respective Hematology Societies. The majority of responders practiced hematology with a similar distribution within a 5-years range, except for Paraguay (10: 92%). The practice setting was highly heterogeneous: public (0-90%), private or health insurance institution (0-56%) and combined (10-75%). The age-target practice was mostly split between adult and pediatric, however restricted to adult patients in Paraguay/Uruguay, and mixed in 49%-Peru.Morphological description is a common practice in LA. Additional initial tests include the histological examination of the BM (87-100%), being mostly done at the institution of attendance (except for Bolivia/Chile). The cytogenetic analysis (70-100%) and immune-phenotyping by flow cytometry is heterogeneous (42% Paraguay- 100% Uruguay). Both studies are mostly referred. Physicians from Chile, Ecuador and Peru selected to introduce the MDS diagnosis as a pre-leukemia, cancer or neoplasia while others avoided these words. The IPSS and IPSS-R are the scoring systems preferred by hematologist from all countries but when it comes to a therapeutic decision age becomes the main factor. Regarding therapies, most responders indicated transfusions of blood components and erythropoietin +/- other growthfactor without differences. Chelation therapy ranged between 0%-Bolivia and 100%-Ecuador. Azacytidine has been highly indicated in 89%-Argentine and in 100%-Ecuador.The average for 5-aza-2'-deoxicytidine was lower (60%-Argentine followed by 33%-Bolivia/Uruguay). Lenalidomide was less indicated in 23%-Chile and 22%-Uruguay. HSCT indication ranged among 33-66% and was not available in Paraguay and Bolivia. The access to clinical trials is significantly limited (8-0%).The suspension of treatment was mainly related to lack of response while chelation-therapy to side effects. This is the first study that explores the real-world clinical practice for MDS in LA showing a heterogeneous access to complementary diagnostic tools, management and treatment in the surveyed countries.