Association of provider experience and clinical outcomes in patients with myelodysplastic syndromes receiving hypomethylating agents

*This work was presented in part in an oral session at the American Society of Hematology meeting in San Diego, California, December 2018.

Abstract

Population level survival of patients with myelodysplastic syndromes (MDS) treated with hypomethylating agents (HMA) is inferior to clinical trials. Using SEER-Medicare data, we identified 2086 MDS patients diagnosed in 2004–13, aged ≥66 years at diagnosis, and receiving ≥1 HMA cycle after 2005. We used multivariate logistic regression and Cox proportional hazards models to assess the impact of provider experience on persistent HMA therapy and overall survival (OS), respectively. Median number of HMA cycles was 4 and median OS was 10 months. Thirty-two percent of patients were treated by providers with ≥1 prior HMA initiation in the last 2 years and were more likely to receive ≥4 cycles of HMA therapy (OR = 1.29, 95% CI = 1.06–1.57; p = .01). No significant association was found between MDS or HMA initiation volume and survival. In conclusion, while HMA initiation volume was associated with persistent HMA treatment, neither MDS nor HMA initiation volumes were associated with OS in older MDS patients.

Keywords:

• Myelodysplastic syndrome
• MDS
• hypomethylating agent
• outcome
• SEER
• Medicare

Acknowledgements

Amer Zeidan is a Leukemia and Lymphoma Society Scholar in Clinical Research and is also supported by a NCI’s Cancer Clinical Investigator Team Leadership Award (CCITLA). The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. The authors acknowledge the efforts of the Applied Research Program, National Cancer Institute; the Office of Research, Development and Information, Centers for Medicare and Medicaid Services; Information Management Services, Inc.; and the SEER Program tumor registries in the creation of the SEER-Medicare database. The interpretation and reporting of the SEER-Medicare data are the sole responsibility of the authors. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Disclosure statement

A.M.Z. received research funding (institutional) from Celgene, Acceleron, Abbvie, Otsuka, Pfizer, Medimmune/AstraZeneca, Boehringer-Ingelheim, Trovagene, Incyte, Takeda, and ADC Therapeutics. A.M.Z had a consultancy with and received honoraria from AbbVie, Otsuka, Pfizer, Celgene, Jazz, Ariad, Incyte, Agios, Boehringer-Ingelheim, Novartis, Acceleron, Astellas, Daiichi Sankyo, Cardinal Health, Seattle Genetics, BeyondSpring, Trovagene, and Takeda. A.M.Z received travel support for meetings from Pfizer, Novartis, and Trovagene. None of these relationships were related to the development of this manuscript. NAP received research funding (institutional) from Boehringer Ingelheim, Astellas Pharma, Daiichi Sankyo, Sunesis Pharmaceuticals, Celator, Pfizer, Astex Pharmaceuticals, CTI BioPharma, Genentech, LAM Therapeutics and Samus Therapeutics. NAP received research funding from Celgene. NAP had a consultancy with and received honoraria from Agios, Alexion and Pfizer. SFH received research funding (institutional) from Celgene, TG Therapuetics, DTRM, Genentech. SFH reports personal fees from Celgene, personal fees from Pharmacyclics, personal fees from Genentech, personal fees from Bayer, outside the submitted work; S.D.G. has consulted for and receives research funding from Celgene. AJD reports grants from Celgene during the conduct of the study; personal fees and other from Abbvie, grants from Boehringer-Ingelheim, grants from Pharmaceutical Research and Manufacturers of America Foundation outside of the submitted work. XM received research funding from Celgene Corp, which supported the development of this manuscript, and consulted for Celgene and Incyte. The other authors have no conflicts of interest to declare.

Data availability statement

SEER-Medicare data cannot be shared by the authors as directed by the SEER-Medicare data use agreement. Data may be requested directly from the National Cancer Institute. However, we are open to sharing our methodology and analytical approaches upon request.

Notes

*This work was presented in part in an oral session at the American Society of Hematology meeting in San Diego, California, December 2018.

Additional information

Funding

Research reported in this publication was in part supported by the National Cancer Institute of the National Institutes of Health under Award Number P30 CA016359. This research was also partly funded by the Dennis Cooper Hematology Young Investigator Award (AZ). The collection of the California cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute (NCI)'s Surveillance, Epidemiology and End Results (SEER) Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention's National Program of Cancer Registries, under agreement #U55/CCR921930-02 awarded to the Public Health Institute.