Myelodysplastic Syndromes Common Among Seniors

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If you have never heard of myelodysplastic syndromes (MDS) before, that may change. This group of serious blood cancers is about five times more common among seniors than previously believed, and presence of the disease places people at much higher risk for heart attack, diabetes, and premature death.

Normally, bone marrow makes blood stem cells that develop into mature, healthy blood cells over time, including red blood cells that carry oxygen, white blood cells that fight infection, and platelets that help the blood to clot. In people who have myelodysplastic syndromes, the stem cells do not mature into red or white blood cells or platelets. The immature blood cells do not function normally and either die in the marrow or soon after they enter the blood stream. The presence of less healthy cells results in infection, fatigue, anemia, and a tendency to bleed easily.

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Until 2001, tumor registries were not required to report MDS as a cancer to the National Cancer Institute’s Surveillance, Epidemiology & End Results (SEER) program. Two years later, the SEER database reported 10,300 new cases of MDS, with a three-year survival rate of only 35 percent.

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The lead author of the new study, Stuart L. Goldberg, MD, a hematologist/oncologist and chief of the division of leukemia at John Theurer Cancer Center at Hackensack, conducted a “head-to-head” study in which he and his team evaluated Medicare claims data for beneficiaries age 65 and older for 2003. They uncovered an estimated 45,000 new cases of MDS, four times the originally reported amount.

Goldberg explained that the vast difference in the statistics is likely due to the different sources of data: Medicare numbers are submitted by both hospital-based and private practice physicians, while SEER data come from tumor registries only, which are mainly in hospitals. Because MDS is usually treated by practitioners in private practice and elderly people with the disease typically are not seen at a hospital until the disease has progressed, the new study found a dramatically greater number of cases.

“As we found in our study,” noted Goldberg, “many apparently die of other causes as their disease progresses.” In fact, when compared with the general American senior population, more than 73 percent of MDS patients had a heart attack within three years of diagnosis while 54.5 percent of the general Medicare population did.

Patients with MDS also had higher rates of diabetes (40% vs 33.1% in non-MDS patients), shortness of breath (49.4% vs 28.5%), and serious blood infection (sepsis, 22.5% vs 6.1%). Three-year survival rate for people with MDS was 60 percent compared with 84.7 percent for the overall Medicare population.

Goldberg says their findings about the higher prevalence of myelodysplastic syndrome among seniors and its complications have “implications for how the disease is treated and hopefully spur additional research.” Progress has been made in the area of treatment. Although the most common therapy for MDS is blood transfusion, four new medications to treat the disease and its complications have entered the market in the last four years. For more information about MDS, you can visit the Myelodysplastic Syndromes Foundation, Inc.

SOURCES:
John Theurer Cancer Center
Myelodysplastic Syndromes Foundation Inc.
National Cancer Institute

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