A hemoglobin >120g/L trends toward improved survival without increasing vascular events in ESA-treated MDS patients

Erythropoiesis stimulating agents (ESAs) are recommended for treating anemia in lower-risk patients with MDS. Hemoglobin (Hb) levels <120g/L are mandated based on thrombosis-risk evidence extrapolated from other cancers. We compared characteristics, cardiovascular events, overall survival (OS) and leukemia-free survival (LFS) in ESA-treated MDS patients who were ESA responders and did/did not achieve Hb levels >120g/L. We conducted a single-center retrospective cohort study of ESA treated MDS patients. Patients who were ESA responders and did/did not achieve a Hb >120g/L were matched 1:1 based on age, sex, and IPSS-R score. Cardiovascular events were assessed by univariate and multivariable logistic regression. Kaplan-Meier OS and LFS curves were compared by log-rank test. 89 patients achieved a Hb >120g/L (Cohort A), and 110 did not (Cohort B). Patients in Cohort A vs B remained on ESA longer (median 36 vs. 18 months, p<0.0001). 21 patients developed cardiovascular events, 11 in Cohort A, 10 in Cohort B at median times of 57 vs 16 months on ESA treatment (p=.38). By multivariable analysis, a previous vascular history (OR 19.2, 95% CI 4.0 - 106.2 p=.0005) associated with cardiovascular events. A higher Hb on ESA treatment was not associated with increased vascular events. In the propensity score matched analysis patients who achieved a Hb >120g/L experienced numerically longer OS (70 vs. 52 months, p=0.41) and LFS (67 vs. 46 months, p=0.31) with no difference in vascular event free survival. A Hb>120g/L on ESA therapy did not associate with increased cardiovascular complications and trended towards improved OS and LFS.