Primary myelodysplasia: Management and outcome at 3 years in 45 patients age 65 and older

OBJECTIVES: To study myelodysplasia in patients age 65 and older. SETTING: A French university hospital. PARTICIPANTS: Forty-five patients age 65 and older with a diagnosis of myel odysplasia made in the hospital between January 1993 and December 1998. MEASUREMENTS: Clinical presentation, initial hematological features, type o f myelodysplasia (French American British classification), treatment, and e volution at 36 months were studied. RESULTS: The mean age of the group was 78. Anemia was the initial hematolog ical feature in 30 patients out of 45 and was symptomatic in 24 patients. R efractory anemia was diagnosed in 20 patients; 11 patients presented with r efractory anemia with excess blast cells, eight with chronic myelomonocytic leukemia. Thirty-one patients received erythrocyte transfusions, no patien t received chemotherapy. At 36 months, 68.8% of the patients were dead. The median survival (22 months) was lower than in other reported series even i n types of myelodysplasia with a classically better prognosis. CONCLUSION: Myelodysplasia is probably underdiagnosed in older people and h as a poor prognosis (median survival 22 months), and no effective treatment is available in older patients.