What are special considerations when treating myelodysplastic syndromes (MDS)?

Updated: Nov 04, 2019
  • Author: Matthew C Foster, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Answer

See the list below:

  • Allogeneic stem cell transplantation is the only potentially curative therapy for MDS

  • Appropriate patients should be referred early for consultation with a transplant specialist, before extensive transfusion support, infectious complications, or transformation to AML

  • Generally, early transplantation is advocated for young patients who are IPSS INT-2–risk and high-risk patients [15]

  • Consider referral for clinical trial participation at any stage of therapy

  • The regimens above have been tested in the frontline setting, and there is no standard of care at the inevitable time of frontline therapeutic failure

  • Clinical trial participation in this situation is highly recommended

  • When considering the choice of a particular therapeutic regimen, it is important to consider the time to best response; the duration of time to response is also critical in evaluating the success of therapies

  • Therapeutic regimens should generally not be changed in the absence of progression or toxicity unless an adequate trial of the current regimen has been undertaken

The median time to response for the therapies listed above is as follows:

  • ESAs with or without granulocyte-colony stimulating factor (G-CSF): 8-12wk [16, 12]
  • Lenalidomide: 4.6wk [17]
  • ATG + cyclosporine: 4mo [18]
  • Azacitidine or decitabine: 1.7 mo [13] to 3 mo [19]
  • 7+3 induction therapy: 4-6wk

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