Epidemiology and Clinical Features of Adults Myelodysplastic Syndromes in Algeria: A Population-Based Study. Review of the Algerian Myelodysplastic Syndromes Study Group

BACKGROUND: In Algeria, the incidence of hematologic malignancies has been difficult to estimate for many years and MDS incidence is unclear because of historical lack of population-based registration and possibly because of under diagnosis. Today, many hematological centers, including 17 university hospitals, have been developed in the entire north and have useful epidemiological data pertinent to MDS. We studied the incidence of MDS and its subtypes, age distribution, geographic distribution and trends in the rate of diagnosis over the last 5 years in Algeria.

DESIGN AND SETTING: Retrospective analysis of nationwide survey of all adult cases of MDS (>16 years) diagnosed between January 2010 and 31 December 2014.

PATIENTS AND METHODS: Patients diagnosed with MDS and referred to all departments of hematology at the 17 participating centers between 2010-2014 were identified. Complete demographic and clinical data, laboratory results, treatment modalities were collected and analyzed.

RESULTS: Between 2010 and 2014, a total of 243 patients with newly diagnosed MDS have been identified. The sex ratio (M/F) is: 1:08, and the median age is 64.3 years (16 - 82 years). Globally, 27% of MDS are diagnosed in the whole Western region of the country, 56% in the Centre, 14% in the East and 3% in the south. The crude mean annual incidence rate of MDS was 0.07 per 100,000 inhabitants aged ≥15 years old. 11.2% patients were less than 45 years and 42% were older than 70 years.4.3% patients were from rural areas and 6, 2 % were cigarette smokers.

Mean hemoglobin level was 7.8 g/dl, mean WBC level was 6134/µl, mean platelets level was 134907/µl, mean VGM level was 92.7 fl and mean ferretin level was 739.31 ng/ml. The mean blood transfusion units were 13.5 units. 36.3% patients had RCMD, 15.9% had RAEB₂ and 13.2% had RAEB₁. 34.4% patients had cytogenetic abnormalities, and del-5q was more commonly encountered in 22.7%. The IPSS-R was very low in 18.3%, low in 18.3%, intermediate in 11.8%, high in 7.5% and non-specified in 36.6%. Treatment regimens were supportive care (transfusion RBC with chelation, and platelets) and growth factors (EPO, Romiplostine, and G-CSF). At the date of end point, 44% of patients were alive, 26% were death and 31% were lost of follow up.

CONCLUSION: Epidemiologic features of our patients are different from the occidental ones. Mean age of presentation of MDS in Algeria is lower than developed countries. The relatively younger age of patients compared to the Western countries may be due to the demographic composition of our population. The annual incidence is still low, but a continuously increasing incidence rate of MDS has been observed throughout the study period and an overall increase in the number of MDS patients diagnosed nationwide over the last five years indicates a need for additional health care resources including curative and therapy-intense strategies, such as stem cell transplant facilities to optimize outcome. Refractory anemia was the most common subtype in both FAB and WHO classification systems and in both genders. The best supportive care was used in all patients in first line treatment and the Iron overload is a permanent feature of MDS.