Access to diagnostic and therapeutic tools for myelodysplastic syndromes in general practice: survey among latin-american hematologists

VIDAL, GABRIELA; MALDONADO, BELLA; REYES, JHEREMY; AYALA, APOLINA; CHOQUE, JUAN; IASTREBNER, MARCELO; NAVARRO, JUAN; UNDURRAGA, M SOLEDAD; ABELLO POLO, VIRGINIA; GRILLÉ, SOFÍA; SALINAS VIEDMA, VICTOR; BELLI, CAROLINA; CRISP, RENÉE; HUAMAN-GARAICOA, FUAD; VALLADARES, XIMENA; PIMENTEL, MAYRA; GUILLERMO, CECILIA; ROYG, MERCEDES

Estocolmo

Congreso; 23rd Congress of the European Hematology Association; 2018

European Hematology Association

Background: MDS refers to a heterogeneous group of closely related clonal hematopoietic disorders. Among the diagnostic andprognostic tools, pathology, cytogenetics, immunophenotyping and, more recently, point mutations have been shown to identifypatients at different risk for survival. Standard treatment options include supportive care, disease-modifying agents and allogeneichematopoietic stem cell transplantation (HSCT).Aims: To assess the real-world hematologist practice patterns within Latin-America (LA).Methods: A printed 23-question survey consisting mainly of multiple-choice questions covering demographics of responders,diagnosis, therapy, evaluation of response, and cause of stopping treatments was collected since August 2015.Results: Among the 458 respondents: 234 were from Argentine, 8 Bolivia, 47 Chile, 17 Colombia, 16 Dominican Republic, 36Ecuador, 10 Paraguay, 64 Peru and 26 Uruguay. The response rate was 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/health insurance institution (0-59%)and combined (10-75%). The age-target practice was mostly split between adult and pediatric, however, restricted to adult patients inParaguay/Uruguay, and mixed in 49%>Peru.Morphological description is a common practice. Additional tests include the histological examination of the BM (87-100%), beingmostly done at the institution of attendance (except for Bolivia/Chile). The cytogenetic analysis (53-100%) and immune-phenotypingby flow cytometry are heterogeneous (42%>100%), being mostly referred. Physicians from Chile, Colombia, Ecuador and Peruselected to introduce MDS diagnosis as a pre-leukemia, cancer or neoplasia while others avoided these words. The IPSS and IPSS-Rare preferred by most hematologists, however, age becomes the main factor for therapeutic decisions. Regarding therapies, mostresponders indicated transfusions of blood components and erythropoietin +/- other growth factor without differences. Chelationtherapy ranged between 0%>Bolivia and 100%>Colombia/Ecuador. Azacytidine has been highly indicated in 89%>Argentine and in100%>Colombia/Ecuador/Dominican Republic. The average for 5-aza-2'-deoxicytidine was lower (77%>Colombia followed by60%>Argentine). Lenalidomide was less indicated in 23%>Chile and 22%>Uruguay. HSCT indication ranged among 33-94% andwas not available in Paraguay/Bolivia/ Dominican Republic. The access to clinical trials is significantly limited (8-0%). Thesuspension of treatment was mainly related to lack of response while chelation-therapy to side effects.Summary/Conclusion: This is the first study that explores the real-world clinical practice for MDS in LA showing a heterogeneousaccess to complementary diagnostic tools, management and treatment in the surveyed countries.