Hypomethylating Agents in the Treatment of High-Risk MDS
Published Online: Thursday, March 6, 2014
For High-Definition, ClickThe treatment of patients with high-risk myelodysplastic syndrome (MDS) who do not appear to respond to hypomethylating agents is challenging, given a lack of effective treatment options. If a patient does not respond to treatment following 4 to 6 cycles of azacitidine or decitabine, evidence suggests it may be beneficial to continue treatment for 9 cycles, if the patient has stable disease, suggests Rami S. Komrokji, MD.
At this point, there are only a few approved treatment options for patients with high-risk MDS, notes Ruben A. Mesa, MD. As a result, progression or intolerance are the primary drivers for switching to an alternative therapy. For patients who progress on hypomethylating agents, the overall outcome is very poor with a median survival of around 4 months, adds Elias J. Jabbour, MD.
For patients with low-risk MDS, it may be appropriate to stop treatment with a hypomethylating agent if a response is not seen after 4 to 6 cycles. In this scenario, the goal is less focused on extending survival and more to control the number of transfusions, Komrokji states.
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Mark J. Levis, MD, PhDDirector, Adult Leukemia Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
Elias J. Jabbour, MDAssociate Professor,
Department of Leukemia,
Division of Cancer Medicine,
MD Anderson Cancer Center, Houston, Texas
Rami S. Komrokji, MDClinical Director, Associate Member, Department of Malignant Hematology
H Lee Moffitt Cancer Center
Ruben A. Mesa, MDChair, Division of Hematology
& Medical Oncology, Mayo Clinic, Scottsdale, Arizona
Rafael Bejar, MD, PhDAssistant Professor of Medicine, Division of Hematology-Oncology
University of California, San Diego, La Jolla, California
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