MDS

Question 1

What are the components of the revised IPSS for MDS?

Answer 1

• Bone marrow blast percentage
• Cytogenetics
• Hemoglobin
• Platelets
• Absolute neutrophil count

Question 2

What are the indications for treatment in MDS?

Answer 2

1) Transfusion dependence
2) Symptoms related to cytopenias
3) Intermediate-2 or high-risk disease

Question 3

What is the treatment of choice for patients with low- or intermediate-risk MDS with predominant anemia and del(5q)?

Answer 3

Lenalidomide

Question 4

What are the frontline treatment options for patients with low- to intermediate-risk MDS and lack a del(5q)?

Answer 4

EPO injections (for EPO < 200) or luspatercept

Question 5

What is the treatment of choice for low- to intermediate-risk MDS with ringed sideroblasts?

Answer 5

Luspatercept

Question 6

Is there any role for iron chelation therapy in patients with MDS?

Answer 6

Only those going to allo transplant

Question 7

What patients with MDS should be considered for immunosuppressive therapy?

Answer 7

• Age < 60
• Hypocellular bone marrow (hypoplastic MDS)
• < 5% blasts
• +PNH clone
• HLA-DR15 haplotype
• +STAT3 mutated T cell clone

Question 8

What are the treatment options for patients with intermediate- to high-risk MDS?

Answer 8

• Allo stem cell transplant (potentially curative)
• HMA

Question 9

How does imetelstat work and which MDS patients should be considered for it?

Answer 9

• telomerase inhibitor
• can be used for low- to intermediate-risk MDS after EPO (usually not given to patients with prior HMA or lenalidomide exposure)