The prognostic value of serum erythropoietin in patients with lower-risk myelodysplastic syndromes: a review of the literature and expert opinion

Ann Hematol. 2020 Jan;99(1):7-19. doi: 10.1007/s00277-019-03799-4. Epub 2019 Oct 25.

Abstract

Myelodysplastic syndromes (MDS) are hematopoietic stem cell malignancies associated with an erythroid maturation defect, resulting in anemia. Treatments for MDS include erythropoiesis-stimulating agents (ESAs). The identification of prognostic markers is important to help predict response and improve outcomes. Various scoring systems have been developed to help predict response to ESAs. Despite limitations in its assessment, serum erythropoietin (sEPO) level is an important predictor of hematologic response to ESAs in patients with lower-risk MDS. Numerous studies have reported significantly lower sEPO levels among responders versus non-responders. Furthermore, treatment response is significantly more likely among those with sEPO levels below versus those above various cutoffs. Other prognostic indicators for response to ESAs include lower transfusion requirement, fewer bone marrow blasts, higher hemoglobin, lower serum ferritin, lower-risk MDS, and more normal cytogenetics. Studies of other MDS therapies (e.g., lenalidomide and luspatercept) have also reported that lower sEPO levels are indicative of hematologic response. In addition, lower sEPO levels (up to 500 IU/L) have been included in treatment algorithms for patients with lower-risk MDS to define whether ESAs are indicated. Lower sEPO levels are predictive of hematologic response-particularly to ESAs. Further, clinical trials should use sEPO thresholds to ensure more homogeneous cohorts.

Keywords: Erythropoiesis-stimulating agents; Erythropoietin; Hematologic response; Myelodysplastic syndromes; Prognosis.

Publication types

  • Review

MeSH terms

  • Activin Receptors, Type II / therapeutic use*
  • Bone Marrow Cells / metabolism
  • Bone Marrow Cells / pathology
  • Erythropoietin / blood*
  • Female
  • Ferritins / blood
  • Hemoglobins / metabolism
  • Humans
  • Immunoglobulin Fc Fragments / therapeutic use*
  • Lenalidomide / therapeutic use*
  • Male
  • Myelodysplastic Syndromes / blood*
  • Myelodysplastic Syndromes / diagnosis
  • Myelodysplastic Syndromes / drug therapy*
  • Myelodysplastic Syndromes / pathology
  • Prognosis
  • Recombinant Fusion Proteins / therapeutic use*
  • Risk Factors

Substances

  • EPO protein, human
  • Hemoglobins
  • Immunoglobulin Fc Fragments
  • Recombinant Fusion Proteins
  • Erythropoietin
  • Ferritins
  • luspatercept
  • Activin Receptors, Type II
  • Lenalidomide

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