Association of provider experience and clinical outcomes in patients with myelodysplastic syndromes receiving hypomethylating agents. Issue 2 (28th January 2020)

• Record Type: Journal Article
• Authors: Zeidan, Amer M.; Hu, Xin; Zhu, Weiwei; Stahl, Maximilian; Wang, Rong; Huntington, Scott F.; Giri, Smith; Bewersdorf, Jan Philipp; Podoltsev, Nikolai A.; Gore, Steven D.; Ma, Xiaomei; Davidoff, Amy J.
• Is Part Of: Leukemia & lymphoma. Volume 61:Issue 2(2020)
• Page Start: 397
• Page End: 408
• Publication Date: 2020-01-28
• Subjects: Myelodysplastic syndrome -- MDS -- hypomethylating agent -- outcome -- SEER -- Medicare; Leukemia -- Periodicals; Lymphomas -- Periodicals; 616.99419
• DOI: 10.1080/10428194.2019.1663423
• Languages: English
• ISSNs: 1042-8194

Abstract

Abstract: Population level survival of patients with myelodysplastic syndromes (MDS) treated with hypomethylating agents (HMA) is inferior to clinical trials. Using SEER-Medicare data, we identified 2086 MDS patients diagnosed in 2004–13, aged ≥66 years at diagnosis, and receiving ≥1 HMA cycle after 2005. We used multivariate logistic regression and Cox proportional hazards models to assess the impact of provider experience on persistent HMA therapy and overall survival (OS), respectively. Median number of HMA cycles was 4 and median OS was 10 months. Thirty-two percent of patients were treated by providers with ≥1 prior HMA initiation in the last 2 years and were more likely to receive ≥4 cycles of HMA therapy (OR = 1.29, 95% CI = 1.06–1.57; p = .01). No significant association was found between MDS or HMA initiation volume and survival. In conclusion, while HMA initiation volume was associated with persistent HMA treatment, neither MDS nor HMA initiation volumes were associated with OS in older MDS patients.