Introduction: Treatment Landscape of 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, January 9, 2014
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Moderator, Harry P. Erba, MD, PhD, introduces a panel discussion exploring recent advances and future strategies for myelodysplastic syndromes (MDS) and chronic myeloid leukemia (CML). The discussion includes expert perspectives from Mark J. Levis, MD, PhD, Elias J. Jabbour, MD, Rami S. Komrokji, MD, Ruben A. Mesa, MD, and Rafael Bejar, MD, PhD.

As a rare disease, diagnosis is a major concern in MDS. In general, the disorder is characterized by ineffective hematopoiesis, peripheral blood cytopenias, and increased risk of progression to acute leukemia. Additionally, Bejar notes, recent advances into the molecular pathogenesis of MDS have allowed for a genetic approach to diagnosis, although this is not yet routinely performed.

There is an approximate 16% discrepancy in the diagnoses made between the community setting and academic institution, where genetic tests are performed more regularly. To create an appropriate treatment plan the biology, pathology, and molecular markers should all be considered, Jabbour believes.

Until recently genetics were not officially incorporated into the diagnostic criteria for MDS, Komrokji states. Cytogenetic changes, such as deletion 5q, are now accepted for a provisional diagnosis, and criteria are beginning to focus more on incorporating molecular changes. Overall, Levis believes, molecular medicine is likely going to change the way MDS is diagnosed with a complete sea change in 5 to 10 years.

While genetics have predictive value, their prognostic value in MDS remains a challenge that still requires refinement, Komrokji believes. One of the ways to obtain more predictive value from genetics in MDS is through the development of more sophisticated targeted therapeutic options, such as those targeting the BCR-ABL mutation in CML, Bejar believes.

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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