Chronological Age Alone Is not Decisive

Letters to the Editor Myelodysplastic Syndromes New Methods of Diagnosis, Prognostication, and Treatment by Dr. med. Kathrin Nachtkamp, Prof. Dr. med. Guido Kobbe, Prof. Dr. med. Norbert Gattermann, and Prof. Dr. med. Ulrich Germing in issue 12/2023

The authors deserve congratulations for this clinically relevant update on the diagnosis, prognostication, and treatment of myelodysplastic syndrome (MDS) (1).

While the article mentions allogeneic hematopoietic stem cell transplantation as the only treatment option with curative potential, Figure 3 suggests that patients older than 70 years are no longer candidates for this treatment. However, numerous studies have provided evidence that comorbidities and general health are more important than chronological age. According to calculations of the German Federal Statistical Office (Destatis), a male patient aged 70 today still has a median life expectancy of 14.3 years and a female patient has a median life expectancy of 17 years, which is significantly higher than the median survival times according to WHO subtypes (under 6 years) (Life Expectancy of Men and Women in Germany – German Federal Statistical Office [destatis.de]).

For this reason, current evidence-based recommendations from international medical societies and the German Society of Hematology and Medical Oncology (DGHO) (Myelodysplastic Neoplasms [Myelodysplastic Syndromes] — Onkopedia) do not include an age cut-off, but the recommendation that counseling of patients with MDS regarding allogeneic stem cell transplantation should rather be based on comorbidities and geriatric assessment (2).

In the German Registry for Stem Cell Transplantation, the number of allogeneic stem cell transplants in patients with MDS aged >70 years has increased from only 27 patients between 2000–2010 to 266 between 2011–2020. Studies on allogeneic stem cell transplantation in patients over 70 years of age with MDS show prospects of cure comparable to those in young patients (3, 4).

Furthermore, according to national and international guidelines in Figure 2, allogeneic stem cell transplantation should also be considered in patients with low-risk and intermediate-1-risk MDS who did not respond to treatment with erythropoietin, lenalidomide or luspatercept or experienced a recurrence after this treatment (2).

DOI: 10.3238/arztebl.m2023.0134

Prof. Dr. med Dr. h.c. Nicolaus Kröger

Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany

Conflict of interest statement

The author declares no conflict of interest.

References

1. Nachtkamp K, Kobbe G, Gattermann N, Germing U: Myelodysplastic syndromes: new methods of diagnosis, prognostication, and treatment. Dtsch Arztebl Int 2023; 120: 203–10

2. DeFilipp Z, Ciurea SO, Cutler C, et al.: Hematopoietic cell transplantation in the management of myelodysplastic syndrome: an evidence-based review from the American Society for Transplantation and Cellular Therapy Committee on Practice Guidelines. Transplant Cell Ther 2023; 29: 71–81

3. Heidenreich S, Ziagkos D, de Wreede LC, et al.: Allogeneic stem cell transplantation for patients age ≥ 70 years with Myelodysplastic Syndrome: a retrospective study of the MDS Subcommittee of the Chronic Malignancies Working Party of the EBMT. Biol Blood Marrow Transplant 2017; 23: 44–52

4. Atallah E, Logan B, Chen M, et al.: Ehab Atallah et al.: Comparison of patient age groups in transplantation for Myelodysplastic Syndrome: the medicare coverage with evidence development study. JAMA Oncol 2020; 6: 486–93