OBJECTIVES: To synthesize the existing literature evidence for patient characteristics, treatment pattern, treatment outcomes, and survival prognosis of elderly patients with myelodysplastic syndromes (MDS) in China.

METHODS: A systematic literature search of major English and Chinese bibliographic databases from 2019 to 2024 was conducted to retrieve published real-world studies including Chinese patients with MDS. The included studies were classified into elderly patient studies (mean age ≥65 years) and non-elderly patient studies (mean age <65 years). The extracted information from the studies in the same age group was synthesized using single-arm meta-analysis and compared using Z-test.

RESULTS: Forty-four studies were included for data extraction and evidence synthesis. The patients from the elderly study group were about 10 years older than the patients from the non-elderly study group (68.4 years vs. 58.2 years, p<0.001). The elderly patients had a significantly higher rates of high IPSS prognostic scores (94.8% vs. 53.5%, p= 0.011) and comorbidity for hypertension (22.9% vs. 8.6%, p<0.001) and diabetes (18.7% vs. 10.6%, p<0.001). The elderly patients were treated more often with demethylation treatment (67.8% vs. 47.4%, p<0.001) but not as often with allogeneic hematopoietic stem cell transplantation (16.9% vs. 26.5%, p=0.009). When treated with demethylation drugs, elderly patients with higher prognostic risk had a lower overall treatment response rate (60.8% vs. 70.0%, p=0.503) and shorter median overall survival (10.9 months vs. 17.9 months, p=0.732). Elderly patients also had shorter leukemia-free survival (12.3 months vs. 16.1 months, p=0.800) and overall survival time after progression to acute myeloid leukemia (4.6 months vs. 13.0 months, p=0.198).

CONCLUSIONS: Managing elderly patients with MDS in China is challenged by more aggressive disease, limited treatment options, reduced treatment efficacy, and poorer survival prognosis.