Hypomethylating Agents in the Treatment of High-Risk MDS

Panelists: Rafael Bejar, MD, PhD, UCSD; Harry P. Erba, MD, PhD, UAB; Elias J. Jabbour, MD, MD Anderson;
Rami S. Komrokji, MD, Moffitt; Mark J. Levis, MD, PhD, Johns Hopkins; Ruben A. Mesa, MD, Mayo Clinic
Published Online: Thursday, March 6, 2014
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The 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.
View More From This Discussion
Episode 1 Introduction: Treatment Landscape of MDS
Episode 2 Discontinuation of Treatment With TKIs in CML
Episode 3 Frontline Treatment of Chronic Myelogenous Leukemia
Episode 4 Second-Generation Tyrosine Kinase Inhibitors in CML
Episode 5 Treatment Selection for Resistant or Intolerant CML
Episode 6 Hypomethylating Agents in the Treatment of High-Risk MDS
Episode 7 Role of Genetic Testing in Myelodysplastic Syndromes
Episode 8 Defining and Predicting Response to HMAs in MDS
Episode 9 Treatment of MDS Refractory to Hypomethylating Agent
Episode 10 Current and Future Treatment Landscape for MDS
Episode 11 Novel Agents and Treatment Strategies in MDS
Episode 12 Oral Azacitidine and Lenalidomide Combinations in MDS
Episode 13 Final Thoughts on Clinical Advances in MDS and CML
Expert Panelists
Harry Erba Moderator

Harry P. Erba, MD, PhD

Professor of Internal Medicine
Director of Hematologic Malignancy Program
University of Alabama
Birmingham, Alabama

Mark J. Levis, MD, PhD

Director, Adult Leukemia Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland

Elias J. Jabbour, MD

Associate Professor,
Department of Leukemia,
Division of Cancer Medicine,
MD Anderson Cancer Center, Houston, Texas

Rami S. Komrokji, MD

Clinical Director, Associate Member, Department of Malignant Hematology
H Lee Moffitt Cancer Center
Tampa, Florida

Ruben A. Mesa, MD

Chair, Division of Hematology
& Medical Oncology, Mayo Clinic, Scottsdale, Arizona

Rafael Bejar, MD, PhD

Assistant Professor of Medicine, Division of Hematology-Oncology
University of California, San Diego, La Jolla, California
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