Managed Care - July 2008 - (Page H3) Myelodysplastic Syndromes: Disease Overview and Therapy Options STEVEN COUTRÉ, MD Associate Professor of Medicine, Stanford University School of Medicine Director, Hematology Clinic, Stanford Hospital and Clinic, Stanford, Calif. proximately 5 per 100,000 individuals among the general population, and between 22 and 45 per 100,000 among those older than 70 (National Comprehensive Cancer The increase in new cases of myelodysplastic Network 2008). Although MDS has yet to be given a syndromes is likely attributable to both an firm ranking among similar diseases in terms of its relaging population and a greater number of ative frequency, with a prevalence of 30,000 to 40,000 in cancer survivors who have received the United States, it is considered a somewhat common hematological disorder. chemotherapy. A detailed diagnostic history Although age is certainly a primary risk factor for is critical in order to place a patient in the MDS, the most important risk factor is prior treatment proper treatment category. for cancer. Treatment with certain types of chemotherapy can significantly increase the risk of developing MDS, Myelodysplastic syndromes (MDS) comprise a group and the combination of chemotherapy and radiation of bone marrow disorders characterized by the undertherapy further heightens the risk. Smoking, already a production of one or more types of blood cells. known risk factor for acute myeloid leukemia This impairment results in at least one of the (AML), also is likely to be a risk factor for MDS. hallmark chronic cytopenias associated with A number of inherited diseases also have been MDS — low blood counts reflected by anemia, linked to MDS, including Fanconi anemia, a thrombocytopenia, or neutropenia. rare inherited form of anemia that greatly increases the risk of developing both leukemia and MDS. Radiation and exposure to certain Epidemiology chemicals have been linked to MDS, and genAccording to the American Cancer Society der also is a slight risk factor, as MDS is some(ACS), no registry was responsible for tracking what more common among men than women. the number of MDS cases until the National Despite the multiple risk factors associated Cancer Institute recently assumed the task; STEVEN COUTRÉ, MD with MDS, the steady increase in the number thus, the exact number of cases found in the of new cases in recent years most likely can be attributed United States is currently impossible to ascertain. Howto an aging population — more than 80 percent of paever, most estimates suggest that between 10,000 and tients are older than 60 — and an increasing number of 15,000 new cases are diagnosed each year (ACS 2007). cancer survivors who have received chemotherapy (ACS The incidence of MDS, which increases with age, is ap2007). Depending on the extent of disease and individual patient needs, the treatment of MDS can have significant Steven Coutré, MD, is an investigator for a number of proeconomic implications. Although a thorough assessment tocols for hematologic malignancies. He is a published auof the economic burden of MDS has yet to be obtained, thor and a nationally renowned speaker in the field of some cost estimates are available. A review of claims data hematology. Coutré received his undergraduate degree from for 336 transfusion-dependent patients with MDS that Northwestern University and his medical degree from Stanincluded total pharmacy costs and medical costs indiford University School of Medicine. His postgraduate traincated that the average annual cost of treating such paing included a residency in Internal Medicine at Yale-New tients was almost $60,000 (Frytak 2007), with significant Haven Hospital, and fellowships in the Division of Hemacosts directly associated with transfusion. For patients, tology, and the Department of Microbiology and Immunolsignificant burdens in terms of reduced quality of life ogy at Stanford. SUMMARY SUPPLEMENT / HEMATOLOGIC CANCER 3
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