Abstract
Molecular genetic testing is an important diagnostic tool for MDS. WHO MDS classification criteria were updated in 2016; how they are implemented in practice is unclear. Our knowledge of molecular testing in elderly patients is limited.
To compare testing patterns in elderly (≥80 years) and younger (<80 years) MDS patients enrolled in the Connect® MDS/AML Disease Registry.
Baseline characteristics and laboratory data were collected from patients enrolled from Dec 12, 2013 to data cutoff Dec 13, 2019 in the Connect® MDS/AML Disease Registry (NCT01688011), an ongoing, US, multicenter, prospective observational cohort study of patients with newly diagnosed MDS (aged ≥18 years) or AML (aged ≥55 years). Testing patterns were compared between elderly and younger MDS patients.
234/800 (29.3%) MDS patients were aged ≥80 years and 566/800 (70.7%) <80 years. Younger patients underwent molecular testing more frequently than elderly patients; 32.5% versus 20.9% (P=0.001). 17/122 (13.9%) elderly patients enrolled before 2017 (<2017) underwent molecular testing versus 32/112 (28.6%) patients enrolled in 2017 or after (≥2017). 47/258 (18.2%) younger patients enrolled <2017 underwent molecular testing versus 137/308 (44.5%) patients enrolled ≥2017. SF3B1 testing rates were lower in elderly patients enrolled <2017 versus those enrolled ≥2017 (0.5% vs 2.4%) and in younger patients (1.9% vs 9.9%). EZH2, ETV6, RUNX1, TP53, and ASXL1 (63.3% each) were the most frequently tested mutations in elderly MDS patients. ASXL1 and TP53 (69.6% each) were the most frequently tested mutations in younger MDS patients. Median number of mutations tested increased between <2017 and ≥2017 for all patients. FISH testing rates were lower in elderly patients enrolled ≥2017 versus those enrolled <2017 (64.3% vs 71.3%) and in younger patients (61.0% vs 75.2%). Cytogenetic testing rates were similar in elderly patients enrolled ≥2017 and <2017 (95.5% vs 98.4%) and in younger patients (97.7% vs 94.2%).
Although molecular testing rates have increased since 2017, testing rates for elderly MDS patients remained lower than for younger patients. Education focused on increasing testing rates in elderly patients is needed to ensure appropriate care. The study was supported by Bristol-Myers Squibb.