NCCN Guidelines for Patients® | Myelodysplastic Syndromes
33 NCCN Guidelines for Patients ® : Myelodysplastic Syndromes, 2018 4 Cancer treatments Immunomodulators | Targeted therapy ATG (equine) and cyclosporine are the main IST drugs that are used to treat MDS. This type of treatment doesn’t work well for all cases of MDS. It tends to work better when MDS has certain features that are linked with an immune system attack. Such features include: Presence of HLA-DR15 tissue type, patients who are transplant eligible will have HLA typing done and this would be identified during routine HLA typing. A low number of cells in the bone marrow Younger age (<60 years) in patients with lower- risk MDS ATG (equine) is given as an IV infusion over a few hours in the hospital. It is often given for 4 or 5 days in a row. Cyclosporine comes as a pill or a liquid that is swallowed. It is given once or twice a day and is continued for at least 6 months. Common side effects of ATG (equine) include fever, chills, and rash at the time of the infusion. Other common side effects are fever, swelling, tiredness, and hives. Though much less common, severe allergic reactions sometimes happen. But, this can be managed with anti-allergic drugs such as prednisone. Possible side effects of cyclosporine are kidney damage, not feeling hungry, high blood pressure, and gum swelling. Immunomodulators Immunomodulators are drugs that modify different parts of the immune system. Lenalidomide is an immunomodulator that is used to treat MDS. It is approved to treat MDS with cells that are missing part of chromosome 5. This chromosome change is referred to as “del(5q).” Lenalidomide treats cancer in more than one way. As an immunomodulator, it boosts the immune system. In this way, it may help the bone marrow to make normal blood cells and help kill abnormal cells in the bone marrow. It also helps stop cancer cells from increasing in number. Treatment with this drug may lessen the need for red blood cell transfusions in some patients. It works best against MDS with the del(5q) chromosome change. Lenalidomide is made as a pill that is swallowed. It is given in cycles of treatment days followed by days of rest. A cycle may consist of 21 days (3 weeks) of treatment and 7 days (1 week) of rest. It may also be given every day for 28 days (4 weeks). Cycles may repeat until the cancer progresses or side effects become severe. Common side effects include low blood cell counts, diarrhea, itching, rash, and extreme tiredness. Ask your treatment team for a full list of side effects. Targeted therapy Targeted therapy is treatment with drugs that target a specific or unique feature of cancer cells. Because these drugs specifically target cancer cells, they may be less likely to harm normal cells throughout your body. Certain treatments may be recommended for the subtype of MDS called CMML. If your doctor knows you have a PDGFRβ gene mutation, he or she may offer treatment with a targeted therapy called Imatinib mesylate ( see Guide 4 ). This drug is a TKI ( t yrosine k inase i nhibitor). It targets certain abnormal proteins that help cancer cells grow. Imatinib mesylate is a pill, given one or two times a day, with a full glass of water. Possible side effects include low blood cell counts, nausea, diarrhea, rash, fever, muscle pain, and extreme tiredness.