NCCN Guidelines for Patients® | Myelodysplastic Syndromes
29 NCCN Guidelines for Patients ® : Myelodysplastic Syndromes, 2018 4 Cancer treatments Supportive care Deferoxamine is a liquid that is slowly injected under the skin over several hours. This is called a subcutaneous infusion. Deferasirox may be given as a tablet that is dissolved in water. Or, it may be given as a pill that is swallowed. With either drug, treatment is given once a day until iron levels have decreased to a safe level. Not all MDS patients, including those with iron overload, need iron chelation. Antibiotics A low number of white blood cells can increase the risk of infections. In some cases, infections may be frequent or severe. If this happens, treatment with antibiotics may be needed. Antibiotics are drugs used to treat infections caused by bacteria, fungi, or viruses. Your doctor may prescribe one or more antibiotics to decrease the risk that you will develop an infection. Drugs for bleeding Thrombocytopenia is a condition in which the number of healthy platelets is too low. This can cause easy bruising or bleeding. In some cases, bleeding problems may be severe or may not improve with platelet transfusions. If this happens, treatment with drugs to improve the function of platelets may be needed. Aminocaproic acid and tranexamic acid are drugs that may be used to control bleeding problems in some patients. These are a class of drugs called antifibrinolytic agents. This type of drug works by stopping blood clots from breaking down too quickly. Blood cell growth factors Blood cell growth factors are substances that cause new blood cells to grow in the bone marrow. Growth factors are made naturally in the body. Copies of these natural factors can also be made in a lab to use as treatment for low blood cell counts. Growth factors may be used to treat anemia, thrombocytopenia, or neutropenia that is causing symptoms. The growth factors that may be used for patients with MDS are described next. White blood cell growth factors White blood cell growth factors may be used as treatment for patients with frequent infections due to neutropenia. There are two main types of white blood cell growth factors. One is called G-CSF ( g ranulocyte c olony- s timulating f actor). The other is called GM- CSF ( g ranulocyte- m acrophage c olony- s timulating f actor). G-CSF helps the body to make a type of white blood cell called neutrophils. Filgrastim is a type G-CSF given with other drugs like red blood cell growth factors (see next section) and lenalidomide for lower- risk MDS. GM-CSF helps the body to make many types of white blood cells. These drugs are liquids that are injected under the skin. Red blood cell growth factors Red blood cell growth factors may be used as treatment for patients with anemia that is causing symptoms. These drugs are also called ESAs ( e rythropoiesis- s timulating a gents) because they stimulate the bone marrow to make new red blood cells. ESAs can increase red blood cell counts in some patients. Such patients may then need fewer red blood cell transfusions. This not only helps with symptoms like extreme tiredness and shortness of breath, but also helps to improve overall quality of life. Epoetin alfa and darbepoetin alfa are ESAs that may be used for patients with MDS. Both drugs are liquids that are injected under the skin. These drugs work best in patients with lower levels of serum EPO. In some cases, G-CSF may be given along with an ESA to improve how well it works.