Erythropoiesis-stimulating agents versus RBC transfusion in MDS: comparison of long-term outcomes

Impaired erythropoiesis and refractory anemia are clinical hallmarks of the myelodysplastic syndromes (MDS). As the disease evolves, a steady decline in hemoglobin in these disorders invariably results in dependence on packed red blood cell (PRBC) transfusion. Such chronic transfusion dependence has been associated with iron overload causing cardio-hepatic toxicity and alloimmunization, and can result in reduced survival in these patients. The use of hematopoietic growth factors, particularly erythropoiesis-stimulating agents (ESAs), has been reported to reduce the need for PRBC transfusion, raise hemoglobin and improve quality of life, at least in patients responding to such a therapy. Importantly, the clinical benefits of ESA are well balanced, with an apparently favorable safety profile in MDS, thus providing an eminent therapeutic option to delay or avoid transfusion dependence in these patients. The present report provides a detailed comparative profile of long-term PRBC transfusions and the balance of clinical benefits versus risks associated with ESA therapy for MDS.