From ASH Meeting on Hematologic Malignancies: What would you recommend for a woman with high-grade MDS and increasing PRBC transfusion needs?

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. Email your response to [email protected].

Patient Case:

Mrs. Holland, a 70-year-old woman with a long-standing history of del5q MDS, now presents with increasing PRBC transfusion requirements. She was diagnosed in 2011, when her local oncologist started her on lenalidomide 10 mg PO BID and she had about 3 years of transfusion independence while on this medication. However, now she has had increasing PRBC needs. She has had a trial of ESA for 3 months and her transfusion requirements have not decreased. Today, her WBC is 3.2 (low), her HGB is 6.5 and her platelet 80. Differential is normal, although ANC 1200 and without blasts.

A bone marrow biopsy is performed and shows a persistent myeloid neoplasm with 30 percent cellularity and 18 percent blasts. Karyotyping shows 46,XX,del(5)(q13q33)[20].

Here’s how MHM attendees would treat this patient:

a. Bone marrow transplant immediately (5%)

b. Increase lenalidomide dose (4%)

c. Hypomethylating therapy with azacitidine/decitabine (72%)

d. Combination therapy with HMT plus lenalidomide (12%)

e. Induction chemotherapy with “7+3” (7%)

ASH Clinical News readers felt the same way:

a. Bone marrow transplant immediately (6.25%)

b. Increase lenalidomide dose (0%)

c. Hypomethylating therapy with azacitidine/decitabine (87.5%)

d. Combination therapy with HMT plus lenalidomide (6.25%)

e. Induction chemotherapy with “7+3” (0%)