Darbepoetin alfa for anemia with myelodysplastic syndrome

Abstract

The myelodysplastic syndromes are characterized by refractory cytopenias that lead to symptomatic anemia, bleeding, and increased risk for infections. For almost two decades, the use of darbepoetin and other erythropoietin stimulating agents to treat symptomatic anemia in lower-risk myelodysplastic syndromes has been a standard of care. This practice is supported by numerous Phase I/II studies and one Phase III study demonstrating the benefit of using erythropoietin stimulating agents alone, or in combination with granulocyte colony stimulating factor, for treatment of symptomatic anemia with the goal of decreasing red blood cell transfusion requirements. This review summarizes the published experience regarding the use of erythropoietin stimulating agents, with a special focus on darbepoetin, in patients with myelodysplastic syndrome and symptomatic anemia.

Keywords:

• anemia
• Aranesp
• darbepoetin alfa
• erythropoiesis stimulating agents
• myelodysplastic syndromes
• transfusion dependent
• treatment

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Erythropoietin stimulating agents (erythropoietin or darbepoetin) can be safely used in appropriate patients to treat symptomatic anemia associated with lower-risk myelodysplastic syndromes (MDS) and can decrease transfusion dependence.

• No study has shown superiority with use of erythropoietin versus darbepoetin in MDS, however, administration may be more convenient with darbepoetin.

• The only randomized Phase III trial performed with erythropoietin stimulating agents thus far did show a survival benefit with erythropoietin stimulating agents when used in conjunction with granulocyte colony stimulating factor to treat symptomatic anemia in patients with MDS.