Hematology

Myelodysplastic Syndromes

Questions discussed in this category

How do you approach severe anemia and thrombocytopenia in an elderly patient whose bone marrow biopsy shows hypercellular marrow with mild dysplasia in erythroid and megakaryocytic lineage but normal cytogenetics and a negative NGS panel?

Hgb is 8 and platelets 10. A very small PNH clone (0.08%) detected. No evidence of hemolysis. No response to steroids. All other anemia/thrombocytopen...

1 Answer available

How do you manage a patient with low risk MDS who achieves transfusion independence with luspatercept but continues to have fatigue?

Is there a role for increasing the dose if not yet maximum? (Hb ~8)

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How do you approach management for CCUS with severe cytopenias?

Bone marrow biopsy does not meet criteria for MDS and no other identifiable cause of the cytopenias.

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What is your approach for choosing between Imetelstat and Luspatercept in managing MDS related anemia?

How would you sequence these therapies given approval for both?

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How do you approach MDS patients with low/very low risk IPSS-R but high risk mutations on NGS?

Do next generation sequencing results influence diagnostic and therapeutic decisions for patients with MDS?

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Would you consider TPO agonists for thrombocytopenia from low risk MDS?

What do you think about the long term risk of AML with romiplostim with longer follow up studies? What about using other TPO agonists like eltrombopag...

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Would you consider using luspatercept for a patient with MDS with anemia refractory to ESA/HMA, that has a SF3B1 mutation but without ringed sideroblasts?

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Would you still recommend bone marrow biopsy in an elderly non-transplant eligible patient with mild cytopenias if NGS from peripheral blood indicates MDS mutations?

If yes, how does that affect management? If no, what are your indications for BM biopsy?

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Are you now using luspatercept as your first choice for anemia management in patients with low-risk MDS otherwise appropriate for EPO initiation, regardless of presence of SF3B1 or ringed sideroblasts?

Per the new data from the COMMANDS trial, Platzbecker et al., PMID 37311468

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What hemoglobin level prompts you to start erythropoietin in a patient with low-risk MDS?

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What are common indications for ordering NGS of peripheral blood?

Would a negative NGS eliminate the possibility of MDS? Is bone marrow biopsy indicated in a patient with pancytopenia with a negative NGS panel?

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Would you offer a bone marrow biopsy to the patient with normal CBC and low MDS-associated mutation burden found on NGS?

E.g. TET2 mutation at < 10% allele frequency

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How do you manage anemia in a patient with myelofibrosis and hemochromatosis?

Patient on JAK2i, ESA, transfusion dependent

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When patients develop headaches from luspatercept, do they tend to improve over time?

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Can a patient with MDS have ring sideroblasts in the absence of mutation such as SF3B1?

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Would you consider complement inhibitor therapy or immunosuppressive therapy (e.g. cyclosporine, corticosteroids) for a patient with a PNH clone and early MDS who presents with pancytopenia?

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What is your approach to CMML-MDS in an older patient with low risk disease who is becoming transfusion dependent?

Would you use a trial of dexamethasone for a patient with thrombocytopenia?

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Do you use GCSF for a patient with MDS with excess blasts and neutropenia?

If so, how do you incorporate GCSF into treatment of these patients?

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How would you approach cytopenias 5 weeks after initial dosing in a young patient with MDS treated with Azacitadine as a bridge to transplant?

E.g. would you dose-reduce or continue at same dose? Baseline ANC was in the normal range

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Would you give IV iron for low TSAT in patients with MDS anemia who are transfusion independent but on an ESA?

i.e. similar to CKD anemia?

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Will you use or have you been using the IPSS-M as the primary way to risk-stratify patients with MDS to determine use of hypomethylating agents?

Will you be using the IPSS-M in place of the IPSS-R? How will you be using IPSS-M in practice?

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Do you routinely send NGS testing from bone marrow samples in patients with unexplained cytopenia or cytoses?

For instance, if clonal hematopoiesis of indeterminate potential (CHIP) suspected

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How do you approach treatment for a patient with hypoplastic MDS who is not eligible for transplant?

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What are non-clinical trial options to treat high-risk MDS in a transplant ineligible patient, after progression on hypomethylating agents?

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How do you manage a patient with transfusion-dependent MDS with concurrent hemochromatosis requiring phlebotomy?

1 Answer available

How do you diagnose MDS in a patient with equivocal morphological findings?

In the case of subtle single lineage dysplasia with normal cytogenetics, do you routinely perform NGS testing for CHIP-type clonal mutations? Do you ...

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Would you routinely use G-CSF prophylaxis in a CMML patient for decitabine-related neutropenia?

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How would you optimally manage a patient with a MDS/MPN overlap syndrome who has both transfusion-dependent anemia and marked thrombocytosis?

Would this change with someone who has a history of thrombosis (e.g. DVT/PE, MI, CVA)? Would this change with someone who is more fit vs more frail?

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Is there a role for frontline combination therapy with a hypomethylating agent plus venetoclax for high risk MDS?

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When do you utilize lenalidomide in patients with MDS without del(5q)?

Are there particular mutations (eg SF3B1) or syndromes (eg MDS/MPN overlaps such as MDS/MPN-RS-T) where you are more apt to using lenalidomide?

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Is there currently a role for adding venetoclax to a hypomethylating agent (HMA) after failure of single-agent HMA therapy in MDS?

Can results from emerging AML data be extrapolated to high risk MDS populations? Is there data to guide the choice of continuing the HMA in combinati...

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Does isolated del(5q) have the same prognostic implications for post-PV secondary myelofibrosis as it does in MDS?

Given the rarity of this in MF, is it still predictive of response to lenalidomide therapy?

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What is your preferred first line treatment for patients with high risk MDS who are not candidates for transplant?

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What is the best strategy after initial treatment with hypomethylating agents for high grade myelodysplatic syndromes, mainly for responders who became transfusion independent?

Do we continue the hypomethylating agent indefinitely?

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How do you choose between azacitidine and decitabine when deciding to treat a patient with MDS with a hypomethylating agent?

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What are your current recommendations for treatment of symptomatic splenomegaly in the setting of myelofibrosis when splenectomy is not an option?