From ASH Meeting on Hematologic Malignancies: How would you treat this patient with high-grade MDS?

Amy E. DeZern, MD, MHS
Hematologist and medical oncologist at the Sidney Kimmel Comprehensive Cancer Center and assistant professor of oncology and medicine at the Johns Hopkins University School of Medicine in Baltimore, Maryland

During their presentations, MHM speakers will be asking the audience how they would respond to patient cases. Audience members will vote live at the meeting via an audience response system, but we want to know what you would do.

CLINICAL DILEMMA

A 76-year-old man noted to have cytopenias at a pre-operative visit for hip replacement had the following characteristics: hemoglobin 11.2 g/dL, mean corpuscular volume 98 fL, white blood cells 2.1×109/L, absolute neutrophil count (ANC) 2.4×109/L, platelet count of 758×109/L.

His complete blood count had been completely normal at a physical exam approximately three months prior to this appointment. A bone marrow biopsy showed hypercellular marrow with 10% to 15% blasts and results from 46,XX and next-generation sequencing are pending. The exam was normal, but he reported having night sweats and having lost three pounds in past three weeks.

He was referred urgently by chief of surgery on Friday afternoon to meet with a hematologist.

How would you manage this patient?

  1. Start azacitidine or decitabine Monday for his MDS, given his ANC and blast percentage
  2. Start prophylactic antibiotics and wait to start active treatment until he becomes transfusion-dependent
  3. Enroll the patient in a clinical trial for high-risk MDS today and starting within 2 weeks
  4. Await mutational data to prognosticate and plan
  5. Recommend the patient visit his lawyer to ensure his will is up to date

Let us know how you would respond at ashclinicalnews@hematology.org!

Here’s how audience members responded:

  • Start azacitidine or decitabine Monday
  • Start prophylactic antibiotics
  • Enroll in a clinical trial
  • Await mutational data
  • Recommend the patient update his will

Here’s how ASH Clinical News readers responded:

  • Start azacitidine or decitabine Monday
  • Start prophylactic antibiotics
  • Enroll in a clinical trial
  • Await mutational data
  • Recommend the patient update his will

Disclaimer: ASH does not recommend or endorse any specific tests, physicians, products, procedures, or opinions, and disclaims any representation, warranty, or guaranty as to the same. Reliance on any information provided in this article is solely at your own risk.

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