From the Guidelines
The initial treatment approach for patients with myelodysplastic syndrome (MDS) should prioritize erythropoiesis-stimulating agents (ESAs) for low-risk patients without del(5q) and lenalidomide for those with del(5q), according to the most recent guidelines 1. The treatment of MDS is highly individualized and depends on the risk stratification of the patient, with low-risk and high-risk patients managed differently.
- For low-risk MDS patients, treatment focuses on supportive care including:
- Red blood cell transfusions for symptomatic anemia
- Platelet transfusions for severe thrombocytopenia
- Antibiotics for infections
- ESAs like epoetin alfa or darbepoetin alfa are first-line for anemic patients with low serum erythropoietin levels (<500 mU/mL) without del(5q) 1.
- For patients with del(5q), lenalidomide is the most effective drug, with a recommended initial dose of 10 mg/day, 3 weeks out of every 4 weeks 1.
- High-risk MDS patients are typically treated with hypomethylating agents, such as azacitidine or decitabine, which work by promoting DNA demethylation and potentially restoring normal gene function 1.
- Allogeneic hematopoietic stem cell transplantation remains the only potentially curative option for eligible patients, typically younger individuals with high-risk disease and good performance status 1. Key considerations in the treatment of MDS include:
- Regular assessment of treatment response, with consideration of alternative approaches if no response is observed
- Management of iron overload, which can have significant clinical consequences, particularly in patients who have received multiple red blood cell transfusions 1
- Psychosocial support and contact with patient support groups, which can improve quality of life for patients with MDS.
From the FDA Drug Label
The FDA drug label for lenalidomide (PO) does not provide information on the initial treatment approach for patients with cell dyscrasia, specifically myelodysplastic syndrome (MDS) 2. The FDA drug label does not answer the question.
From the Research
Initial Treatment Approach for Myelodysplastic Syndrome (MDS)
The initial treatment approach for patients with myelodysplastic syndrome (MDS) depends on various factors, including the patient's risk category, age, and performance status.
- Supportive care is a major option for lower-risk, older patients with MDS or those with comorbidities, and includes hematopoietic growth factors, red blood cell or platelet transfusions, and antimicrobial agents 3.
- For lower-risk MDS patients, therapeutic objectives aim to correct chronic anemia and improve/maintain health-related quality of life (HRQoL) 4.
- Erythropoiesis stimulating agents (ESAs) are commonly used as first-line treatment for anemia in lower-risk MDS patients without del(5q), while lenalidomide is used for patients with del(5q) 5, 6.
Treatment Options for Lower-Risk MDS
Treatment options for lower-risk MDS patients include:
- Supportive care, such as red blood cell transfusions and iron chelation therapy 5, 4
- Erythropoiesis stimulating agents (ESAs) for patients without del(5q) 5
- Lenalidomide for patients with del(5q) 5, 6
- Hypomethylating agents, such as azacitidine and decitabine, for patients who are refractory to ESAs and/or lenalidomide 3, 5
Considerations for Treatment
When considering treatment options for MDS patients, it is essential to take into account the patient's individual characteristics, such as age, performance status, and comorbidities 7.