The MDS Beacon™

Researchers at the Fundeni Clinical Institute in Bucharest, Romania recently published a statistical analysis of the prevalence of myelodysplastic syndromes (MDS) in Romania compared to Western and Eastern countries. The report will appear in the November issue of Leukemia Research.

The study findings indicate an increase in the number of new MDS cases since 1982, a low median age of patients, a high proportion of young patients, and a low proportion of patients over the age of 80. Most of the findings situated Romania between Western countries and Eastern countries.

In correspondence with The MDS Beacon, Dr. Radu Gologan, one of the study authors, commented on how the study results may indicate a geographic difference in MDS. “For us it was a real surprise to find that some significant epidemiological data in Romania are placed almost in the middle between the Western and Eastern countries in the world, indicating a possible geographical-ethnic correlation. In Romania there were many oriental migrations over the centuries, especially in the southern part of the country where Fundeni Hospital is situated, and this could explain the intricate epidemiological data.”

The study was conducted on recorded data from 424 adult MDS patients hospitalized between 1982 and 2005. Researchers organized data based on gender, age groups, MDS subtypes, and the number of new cases each year. They then analyzed the distributions against previous studies conducted in Germany, Spain, and China. They also cited data published in other countries.

The researchers found that most of the Romanian data falls between Western and Eastern data. Regarding age distribution, MDS cases were most frequent between the ages of 51 and 80. Romania also was more similar to China rather than Western countries in having an increased proportion of younger patients and a very low proportion of patients over the age of 80. Researchers speculate that this is in part due to the low population of Romanians over the age of 80.

The findings put Romania between Western and Eastern countries in male to female ratio of MDS cases. In all three regions, more males were affected than females. China had the highest ratio, meaning there is a greater difference in the number of Chinese males versus the number of Chinese females diagnosed with MDS than there is in Romania. The same relationship appeared comparing Romania to Spain and Germany.

Regarding MDS subtypes, Romania was in the middle again. Notable findings include similarity to Western data on lower-risk subtypes and similarity to Eastern data on higher-risk subtypes.

Findings also showed an increase in MDS cases over time. Researchers discussed that this is likely attributable to better diagnosis techniques and medical care rather than a real increase in new MDS cases. However, the authors note that in Romania, the increase in diagnoses surpassed the aging of the population, meaning that the aging population may not account for the increase in MDS diagnoses and there may have been a true increase in the disease.

In the past few years, MDS diagnosis in Romania has become more accurate and more sophisticated techniques are being used; Gologan described such techniques including routine study of cell structure and function (cytogenetics), agents stimulating red blood cell production and development (erythropoiesis), and improved methods of blood cell transfusions. Gologan added that Vidaza (azacitidine) and Dacogen (decitabine) are not yet covered in Romanian insurance programs, though they were recently approved in Europe.

Table: Comparative findings from the study

*Subtype abbreviations are as follows: Refractory Anemia (RA); RA with ringed sideroblasts (RARS); RA with excess blasts (RAEB); RAEB in transformation (RAEB-t); Chronic myelomonocytic leukemia (CMML).

The researchers discussed possibilities for regional differences in MDS data. For Romania, they discuss that toxicity in neighboring developing countries and other exposure to chemicals may influence the disease prevalence. Furthermore, they indicate that the high rural population in Romania with low socioeconomic resources may have limited access to hospitals, thus altering the data obtained.

One other aspect of the study findings was an apparent difference in age groups. Gologan described the plan for future study on age groups: “Because in our MDS Registry we found a non-negligible proportion of young patients, we will analyze the under 50 years group in comparison with the over 60 years group, trying to contribute to the issue of the existence of the so-called categories ‘young’ and ‘old’ MDS.”

The researchers also suggested that more comprehensive studies should be done in other Romanian hospitals as well as in neighboring countries. They hope to investigate if neighboring countries have similar data between Eastern and Western data. If so, they may be able to better identify similarities and differences in the regions that explain the results of this study. If more concrete differences can be identified among regional groups and age groups, physicians can better categorize diagnoses and prescribe the most beneficial therapies.

Dr. Gologan’s group at the Fundeni Hospital is ultimately most interested in contributing to awareness of the frequency and importance of MDS. According to Gologan, “A good epidemiological assessment will provide to the public health officials enough data for appropriate funding for the care of MDS patients and to pharmaceutical companies for better planning for their research and production efforts.”

For more information, please see the study in Leukemia Research (abstract).