Primary myelodysplasia: management and outcome at 3 years in 45 patients age 65 and older

To study myelodysplasia in patients age 65 and older.

A French university hospital.

Forty-five patients age 65 and older with a diagnosis of myelodysplasia made in the hospital between January 1993 and December 1998.

Clinical presentation, initial hematological features, type of myelodysplasia (French American British classification), treatment, and evolution at 36 months were studied.

The mean age of the group was 78. Anemia was the initial hematological feature in 30 patients out of 45 and was symptomatic in 24 patients. Refractory anemia was diagnosed in 20 patients; 11 patients presented with refractory anemia with excess blast cells, eight with chronic myelomonocytic leukemia. Thirty-one patients received erythrocyte transfusions, no patient received chemotherapy. At 36 months, 68.8% of the patients were dead. The median survival (22 months) was lower than in other reported series even in types of myelodysplasia with a classically better prognosis.

Myelodysplasia is probably underdiagnosed in older people and has a poor prognosis (median survival 22 months), and no effective treatment is available in older patients.