From the Research
Angioedema in a patient with myelodysplastic syndrome (MDS) being treated with a tyrosine kinase inhibitor (TKI) requires immediate discontinuation of the TKI as this is likely a drug-induced reaction. The patient should be assessed for airway compromise and treated with antihistamines (diphenhydramine 25-50mg IV/PO), corticosteroids (methylprednisolone 125mg IV or prednisone 40-60mg PO), and epinephrine (0.3-0.5mg IM) if there are signs of anaphylaxis or respiratory involvement 1. TKIs, particularly those used in MDS, can cause angioedema through mast cell degranulation or bradykinin pathway activation. Once the acute episode resolves, the treating oncologist should be consulted to determine an alternative treatment strategy for the MDS. Options may include switching to a different class of medication, attempting a different TKI with careful monitoring, or implementing a desensitization protocol under specialist supervision. Some of the available therapies for MDS include growth factor support, lenalidomide, hypomethylating agents (HMAs), intensive chemotherapy, and allogeneic stem cell transplantation (alloSCT) 1. Patients should be prescribed an epinephrine auto-injector for emergency use and educated about avoiding the culprit TKI in the future. Long-term management may include referral to an allergist/immunologist for further evaluation and skin testing to confirm the specific drug allergy. It is essential to consider the patient's age, comorbidities, and potential for alloSCT when formulating the optimal treatment plan, as age itself should not be an absolute contraindication to therapy 2. The goal of therapy in MDS is to decrease transfusion needs, reduce the risk of transformation to higher-risk disease or acute myelogenous leukemia (AML), and improve survival, with the choice of therapy depending on the patient's risk profile, transfusion needs, and other factors 1. In the context of MDS treatment, tyrosine kinase inhibitors have been explored, but their efficacy and safety profiles vary, and they may not be effective in all patients, as seen in a study where imatinib mesylate did not achieve a significant clinical response in patients with AML or MDS 3. Given the complexity of MDS and the potential for drug-induced reactions, a personalized approach to treatment, taking into account the latest evidence and guidelines, is crucial to optimize patient outcomes and quality of life.