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Editorial theme | Supportive care for MDS

Sep 1, 2022
Learning objective: After reading this article, learners will be able to recall how anemia management can be improved in MDS.

Erythropoiesis-stimulating agents (ESAs) are used as a supportive care therapy for anemia, which patients with lower-risk myelodysplastic syndromes (MDS) experience.1 ESAs may reduce the need for red blood cell (RBC) transfusion in patients with MDS and improve their quality of life (QoL). However, it is unclear whether ESA treatment should be initiated before there is a need for RBC transfusion, or after.1

As part of our editorial theme looking at supportive care in MDS, here, we summarize a study by Garelius et al.,1 which analyzed patients registered in the European MDS Registry (EUMDS). The EUDMS is a prospective multicenter European registry for patients with newly diagnosed MDS, which started in 2008 and aims to collect and describe information on MDS and improve the diagnosis and treatment of patients with MDS.1

The primary objective of the Garelius, et al. study was to assess the effect of treatment with or without ESAs and/or RBC transfusion on the overall survival (OS) and quality of life (QoL) of patients with lower-risk MDS.1 The results were presented at the European Hematology Association (EHA) 2022 Congress.


The EUMDS registry was a noninterventional longitudinal study that included patients from 16 European countries and Israel, with the following characteristics:

  • lower-risk MDS;
  • diagnosed before July 2019;
  • hemoglobin levels <10 g/dL; and
  • comparable propensity scores between the ESA and no-ESA groups.

Patients were stratified into two groups based on whether they had received ESA treatment and analyzed based on meeting the eligibility criteria (Figure 1).

Figure 1. Patient eligibility for analysis* 

ESA, erythropoiesis-stimulating agent; Hb, hemoglobin.
*Data from Garelius, et al.1 

OS was measured from the time of the first visit with a hemoglobin level <10 g/dL, and was assessed for patients treated with ESAs stratified by their transfusion status prior to commencing ESA treatment (no RBC transfusion, <4 units, ≥4 units).

Patients were separated into four groups at each clinical visit: no ESA nor RBC transfusion, ESA only, ESA and RBC transfusion, and RBC transfusion only.

Quality of life

QoL was analyzed per treatment group via an EQ-5D questionnaire completed at visits 1 and 2 and up to visit 6, with mean values compared by treatment group. QoL was assessed for 695 patients.


Patients receiving ESA treatment demonstrated higher median OS rates than those not receiving ESA treatment (Figure 2; p < 0.003). OS was lower in patients who underwent RBC transfusion prior to starting ESA treatment (p < 0.001).

Figure 2. Median overall survival of ESA-treated patients and non-ESA-treated patients*

ESA, erythropoiesis-stimulating agent; OS, overall survival.
*Data from Garelius, et al.1

 Patients who received no treatment reported the highest mean QoL based on the EQ-5D scale, patients who received ESA treatment also had high QoL scores, while patients who received RBC transfusions had the lowest (p < 0.001). There was no significant difference between patients who did or did not receive ESA treatment and also received RBC transfusions in terms of QoL.


This study demonstrates a significant improvement in OS for patients with lower-risk MDS who receive ESA treatment at the onset of anemia but before the need for RBC transfusion. ESA treatment was associated with a higher QoL than RBC transfusion and RBC transfusion with ESA treatment.

  1. Garelius H, Smith A, Bagguley T, et al. S168: Erythropoietin stimulation agents significantly improves outcome in lower risk MDS. 2022;6:69-70. DOI: 10.1097/01.HS9.0000843564.40783.b4


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