Erythropoietin treatment in patients with myelodysplastic syndromes and type 2 diabetes.

Background: The aim of the present study was to assess the role of a concomitant type 2 diabetes as a potentially negative factor in the management of low-risk myelodysplastic syndrome (MDS) patients treated with high-dose (40 000 UI s.c. 2 times/week) recombinant human erythropoietin (EPO) alpha (rHuEPO alpha). Methods: One hundred and forty patients (M/F 69/71, median age 76, interquartile range [IR] 68–81) were included in the analysis: 27/140 (19.2%) had a concomitant type 2 diabetes. Results: No difference was reported between patients with and without diabetes as to the grade of anemia, the EPO endogenous levels and the need for transfusional requirement at baseline. Erythroid response was achieved in 79/140 patients (56.4%): factors associated with response were lower EPO levels (P < 0.0001), higher baseline Hb levels (P < 0.0001) and transfusion independence (P < 0.0001). Diabetes was not predictive of response: 17/27 (62.9%) patients with diabetes were responsive to high-dose EPO compared with 62/113 (54.8%) patients without diabetes (P = 0.446). This was confirmed in multivariate analysis, controlling for the effects of Hb levels, transfusiondependence and serum EPO levels. No difference was observed in relapse rate, response duration and OS between patients with and without diabetes. Conclusions: Concomitant type 2 diabetes was not a major concern in the management of MDS patients.