NCCN Guidelines for Patients® | Myelodysplastic Syndromes
42 NCCN Guidelines for Patients ® : Myelodysplastic Syndromes, 2018 5 Treatment guide Lower-risk MDS with anemia Lower-risk MDS with anemia Guide 5. Initial treatment for lower-risk MDS with anemia Test results Treatment options del(5q) ± one other chromosome change ª • Lenalidomide No del(5q) ± other chromosome changes, and Serum EPO ≤500 mU/mL ª • Epoetin alfa ± G-CSF, or • Darbepoetin alfa ± G-CSF No del(5q) ± other chromosome changes, and Serum EPO >500 mU/mL ª If likely to respond to IST: • ATG (equine) + cyclosporine If not likely to respond to IST: • Azacitidine • Decitabine • Consider lenalidomide • Clinical trial Guide 5 shows the treatment options for patients with lower-risk MDS and anemia that is causing symptoms. The options differ based on the types of chromosome changes in the MDS cells and the level of EPO in your blood. One key chromosome change is when MDS cells are missing part of chromosome 5. This change is called del(5q). The amount of natural EPO in your blood is called the serum EPO level. Treatment options for MDS with del(5q) If MDS cells have the del(5q) chromosome change occurring alone or with one other chromosome abnormality (except any abnormality related to chromosome 7), treatment with lenalidomide may be recommended. This drug should not be given if you have an abnormal chromosome 7, a complex karyotype (3 or more abnormalities), or a very low number of neutrophils or platelets. Your doctor will also give tests during treatment to check your blood cell counts and watch for side effects. These tests are also used to check how well treatment is working. An outcome or improvement caused by treatment is called a treatment response. Patients who start lenalidomide often require more transfusion support during the first 3 to 4 months of treatment, but then improve. Lenalidomide can increase the risk of blood clots, so talk to your doctor about the use of aspirin or anticoagulation medicine to decrease this risk.