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[Retrospective analysis of hemotherapy support in 226 cases of myelodysplastic syndromes].

PURPOSE
To evaluate the transfusion requirements (red cells and platelets) in 226 patients with myelodysplastic syndromes (MDS).


PATIENTS AND METHODS
The number of patients under study was 226: 59 with refractory anaemia (RA), 49 with sideroblastic anaemia (RSA), 56 with refractory anaemia with excess of blast cells (RAEB), 48 with RAEB in transformation (RAEBT), and 14 with chronic myelomonocytic leukaemia (CMML). The period of the study was from January 1975 to December 1992. The mean age of the series was 67.4 years (ranging between 28 and 92) and the male/female ratio was 1.8. Transfusion frequency (TF) was defined as the time elapsed between two consecutive transfusions of two units of packed red cells. A platelet transfusion (PT) was comprised of 6 units of platelets or 1 unit obtained by thrombopheresis. The statistical analysis was performed with the chi 2 and Student's tests.


RESULTS
Anaemia was present in 96.9% of the patients, regardless of the cytologic classification. Haemorrhages appeared in 41.6% of the cases with maximal frequency in CMML (78.6%) and minimal in RSA (10.2%). TF: Transfusion was required by 90.2% of the patients (86% of the RA, 79.6% of the RSA, 48.4% of RAEB, 97.9% of the RAEB-T, and 100% of the CMML). The mean TF was 1.5 months (1.9 for RA, 1.7 for RSA, 1.3 for RAEB, 0.9 for RAEB-T, 2.2. for CMML). PT: Platelet support was needed by 38.1% of the patients (30.5% of RA, 8.1% of RSA, 48.2% of RAEB, 58.3% of RAEB-T and 64.3% of CMML). The mean number of PT per patient was 7.2 (5.2 for RA, 3.8 for RSA, 9.7 for RAEB, 10.2 for RAEB-T, 7.1 for CMML).


STATISTICAL ANALYSIS
The differences appreciated in TF were significant for the good prognostic groups (RA + RSA) as compared with the poor-risk ones (AREB + AREB-T + CMML) (p < 0.01), although significance is lost when these groups were taken one by one. For PT, significant differences appeared when comparing RA + RSA with RAEB + RAEB-T + CMML (p < 0.001); when the groups were compared one by one, significant differences were found only for RA versus RSA (p < 0.01).


CONCLUSIONS
1) Red cell support was required by 90.2% of the patients with MDS, while platelet support was needed in 38.1% of the cases. 2) The cytologic poor-risk groups (RAEB, RAEB-T and CMML) required greater transfusion support as a whole than did the good prognostic ones (RA + RSA). 3) However, only RA showed significant differences with respect to RSA regarding PT, the remaining groups showing no such differences. 4) An irregular pattern was seen in RA and CMML with respect to PT in the former and to both TF and PT in the latter.