Myelodysplastic syndrome in Tanzania; The current status of management Free

Introduction Myelodysplastic syndromes (MDS) are hematopoietic disorders characterized by ineffective hematopoiesis, peripheral cytopenias, dysplasia in one or more myeloid lineages, and an increased risk of developing acute myeloid leukaemia (AML). While MDS has been extensively studied over the past decade by most resource-rich countries, and the quest for advancing disease diagnostics and precision medicine is improving, this is unfortunately not the case in most low-income countries. Herein, we report the current status of the management of MDS patients evaluated at Muhimbili National Hospital (MNH), Tanzania.

Methods A retrospective cross-sectional study was conducted involving 63 patients diagnosed with MDS between 2018 and 2023 at MNH. Data about their clinical presentation, laboratory findings (including bone marrow biopsy results), and treatment options were extracted from electronic medical records and patient files for all adults morphologically diagnosed with MDS. Descriptive statistics, Kaplan-Meier survival analysis, and logistic regression were conducted using SPSS.

Results

Of the 63 patients enrolled, 40 (63.5%) were male and 23 (36.5%) were female. The median age at diagnosis was 67 years (range: 50–84). The most common presenting symptoms were fatigue, reported by 57 patients (90.4%), followed by dizziness in 51 patients (80.9%). Anemia was the most frequent laboratory abnormality, identified in 90% of cases. The median hemoglobin level was 6.5 g/dL (range; 2.9-11.89), the median platelet count was 47.9 × 10⁹/L (range: 2.67-488), and the median absolute neutrophil count was 0.83 × 10⁹/L (range: 0.086-21.6). Transfusion dependence was noted in 34.2% of patients.

Cytogenetic testing was not performed in 59 patients (96.7%) due to limited availability, and molecular testing was not available for any patients. Risk stratification using the International Prognostic Scoring System (IPSS) classified 23.8% of patients as low risk, 34.9% as intermediate risk, and 41.2% as high risk, acknowledging the limitations of this assessment in the absence of cytogenetic data.

Supportive care with blood transfusions was the primary treatment for 57 patients (93.4%). Erythropoiesis-stimulating agents, lenalidomide, and cyclosporine were administered to 4.9%, 6.6%, and 8.2% of patients, respectively. Azacitidine, a hypomethylating agent, was offered to only 1.6% of patients. No patients received novel targeted therapies or hematopoietic stem cell transplantation.

During the follow-up period, a significant proportion (36.5%) were lost to follow-up. The median survival for patients ≤ 60 and > 60 years old was 6.7 and 8.3 months, respectively. At the time of this reporting, only 9.5% are confirmed to be alive. No statistically significant predictors were found for death among age, gender, cytopenia, IPSS score, or comorbidities, with the limitation of small sample size.

Conclusions The findings from this study reveal a concerning gap in the comprehensive management of MDS in Tanzania. Despite the diagnosis from bone marrow biopsy, the absence of cytogenetic and molecular diagnostics, as well as the lack of risk stratification, precluded the appropriate identification of clinical categories and tailored treatment for the patients. Supportive care remains the mainstay of management, with limited use of disease-specific therapies. This emphasizes the pressing need to strengthen diagnostic infrastructure and make treatment options available to align with global standards and improve the outcomes of MDS patients in low-resource settings.