Treatment of MDS Refractory to Hypomethylating Agent

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: Monday, April 21, 2014
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Few treatment options exist for patients with myelodysplastic syndromes (MDS) who progress on hypomethylating agents, such as azacitidine and decitabine. In this setting, for patients with high-risk MDS, the median survival is 4 to 6 months, states Elias J. Jabbour, MD. The best option at this point is a clinical trial.

For patients with low-risk MDS, the median survival for patients following progression on hypomethylating agents is nearly 17 months, Jabbour states. Moreover, the rate of transformation to acute myeloid leukemia is low. In this setting, the most effective options appear to be bone marrow transplant or a clinical trial, adds Rami S. Komrokji, MD.

Numerous clinical studies have examined commercially available agents and combinations following progression, notes Ruben A. Mesa, MD. However, none of these data have transformed the standard of care, since it is unclear if one combination is superior to another. Moreover, none of the trials have resulted in FDA approval.

A clinical trial following progression on hypomethylating agents is the clear favorite of the panel. Unfortunately, access to trials is not always feasible, particularly in the community setting, adds Harry P. Erba, MD, PhD. This fact places more importance on rapidly discovering an optimal and widely available approach.
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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