Final Thoughts From ASH 2019 on MDS


Mikkael Sekeres, MD, MS: We’re going to wrap up, and we’ll do a little bit of a round-robin. I’ll ask each of you: if there’s 1 point you want to communicate about MDS [myelodysplastic syndrome] from everything we’ve discussed, what would that be? I’ll start with Jamile.

Jamile M. Shammo, MD: I’d like to say that the disease is highly heterogeneous, that we shouldn’t underappreciate that point. Even though we have available therapies, we should all think about including patients on clinical trials. That’s extremely important. It’s about time that we get second-line treatments after around 12 years of no new therapies. Hopefully, we’ll have increase in accrual to clinical trials in MDS.

Mikkael Sekeres, MD, MS: Ellen?

Ellen K. Ritchie, MD: I would like to add to that, but it’s really important to look at the patient in front of you and to actually try to figure out and be able to communicate to that patient what their disease is, what the prognosis is, and to choose a therapy for them. But 1 of the things that’s so disappointing about clinical trials is that we really are underrepresented in that over-75 group, and I think that sometimes there’s a bias against enrolling those patients, who are a little more frail and a little older, on clinical trial. I would hope that people start looking at those patients and try to include them on clinical trials. We need to make a very strong effort to bring these older patients who are a little more frail onto clinical trial, with the complete realization that by the year 2030, 12% of the population is going to be over age 80. These are going to be people who we will hopefully, with our 25-year-old muscles, be treating. We need to have good data in order to treat these older patients.

Mikkael Sekeres, MD, MS: Nicely stated. Rami?

Rami Komrokji, MD: I’m hoping that we’re on the verge of still introducing several new drugs for patients with MDS and hopefully being able to improve the outcome for our patients. Again, none of them could be a cure, but they are definitely going to be improvement for the patients, whether it’s decreasing transfusion dependence here or improving outcome in bad disease. For my colleagues in oncology practice, I would say it’s always helpful to go through 3 steps.

First, verify your diagnosis. Make sure you have the right diagnosis, because there are so many things that can look like MDS. Get all the testing that’s needed. I think mutational testing is helpful. Risk stratify the patients and tailor treatment accordingly. Think of a transplant for patients who have high-risk features because it still remains as the only curative option for those patients if they are a candidate. Stepwise treatment for lower risk is reasonable. Anytime we restore hematopoiesis for patients, we probably are helping them, whether in quality of life or survival. Hopefully in a year or 2, we’ll have 3 or 4 drugs approved for our patients.

Mikkael Sekeres, MD, MS: We keep hoping. That would be great. I have to say that if I had MDS, I would want any 1 of you to be my doctor. Thank you for joining me today. On behalf of our panel, we hope you found this Peer Exchange® to be useful and informative.

Transcript Edited for Clarity

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