Recommendations of Estey for Therapy of Low Risk Myelodysplastic Syndrome (MDS) to Reduce the Need for Blood Transfusions

 

Selection: myelodysplastic syndrome with IPSS score low risk or intermediate-1

 

Parameters:

(1) 5q- on cytogenetics

(2) serum erythropoietin concentration in mU/mL

(3) likely to benefit from immunosuppression

5q- Present	Serum Erythropoietin	Immunosuppression Benefit	Therapy
Yes	NA	NA	lenalidomide
No	< 500 mU/mL	NA	(erythropoietin or darbepoetin) with or without G-CSF
No	>= 500 mU/mL	Yes	anti-thymocyte globulin (ATG)
No	>= 500 mU/mL	No	azacitidine or decitabine or investigational

 

where:

• A patient with 5q- is less likely to respond to lenalidomide if thrombocytopenic or required > 4 units of packed RBCs during the 8 weeks prior to evaluation.

• Lenalidomide can be used in patients without 5q- but has more side effects than alternative therapies. It may be considered if these fail to achieve the desired effect.

• Immunosuppression may benefit a patient with evidence of an autoimmune basis for the myelodysplasia or HLA-DR15 positive.