From ASH Meeting on Hematologic Malignancies: How would you treat MDS that has not responded to azacitidine?

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. Send in your responses for a chance to win an ASH Clinical News-themed prize!

CLINICAL DILEMMA

A 62-year-old man who was diagnosed with myelodysplastic syndromes nine months ago presents with:

  • Hgb 7.2 g/dL
  • MCV 108 fL
  • WBC 1,900/µL
  • ANC 740/µL
  • platelet count 41,0000/µL

Bone marrow biopsy showed hypercellularity and 11 percent blasts, consistent with refractory anemia with excess blasts-2. Karyotyping showed 46,XY,del(20).

He received eight cycles of seven days of azacitidine 75 mg/m2 intravenously. He experienced no toxicity, but remained red blood cell transfusion–dependent (2 units/month). After cycle eight, a bone marrow biopsy showed 18 percent blasts. Karyotyping showed 46,XY,del(20). His Karnofsky performance status is 80 percent.

This patient wants to consider all available options for his therapy. What would you offer him now that azacitidine has not been effective?

  1. Monthly transfusion support
  2. Switch to decitabine
  3. Add another agent to azacitidine
  4. Treat like acute myeloid leukemia, with 7+3 of cytarabine and an anthracycline
  5. Look for a clinical trial at the nearest academic center
  6. HLA type and move to hematopoietic cell transplantation ASAP

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.

Here’s how audience members and ASH Clinical News readers responded:

MHM Audience Responses

  • Switch to decitabine
  • Add another agent to azacitidine
  • Treat like acute myeloid leukemia, with 7+3
  • Look for a clinical trial at the nearest academic center
  • HLA type and move to HCT ASAP

ASH Clinical News Reader Responses

  • Switch to decitabine
  • Treat like acute myeloid leukemia, with 7+3
  • Look for a clinical trial at the nearest academic center
  • HLA type and move to HCT ASAP

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