NCCN Guidelines for Patients® | Myelodysplastic Syndromes

46 NCCN Guidelines for Patients ® : Myelodysplastic Syndromes, 2018 5 Treatment guide Higher-risk MDS Guide 8 shows the treatment options for higher- risk MDS. To help decide which option is best for you, your doctor will first assess if you are able to have high-intensity treatment. High-intensity treatment includes allogeneic HCT and high- intensity chemotherapy. Treatment with high-intensity chemotherapy in a clinical trial is preferred. High-intensity treatments aim to slow or stop MDS progression to AML and improve survival. But, they can also cause very bad side effects. Side effects are often more severe for patients who are older or have other health problems. Not all patients can tolerate the severe side effects. Your doctor will look at many factors to decide if high- intensity treatment is a good option for you. Such factors include your personal preference, your age, how well you can do daily activities, and other health conditions. Another key factor is if there is a well- matched donor for the allogeneic HCT. If an allogeneic HCT is a good option for you and a donor has been found, there are three main options to choose from. The first option is to receive an allogeneic HCT right away. High-dose conditioning or reduced-intensity conditioning may be used for the HCT. (See page 35 for more details about conditioning treatment.) The second option is to receive azacitidine or decitabine first and then an allogeneic HCT. This may be used to lower the number of blast cells in your bone marrow before the HCT. It may also be a good option if you are still waiting for a well-matched donor. The third option is to receive high-intensity chemotherapy first and then an allogeneic HCT. High-intensity chemo as part of a clinical trial is preferred. The high-intensity chemo can help to lower the number of blast cells in your bone marrow before the HCT. But, it can cause very severe side effects and may not be a good choice for all patients. Higher-risk MDS Guide 8. Initial treatment for higher-risk MDS Assessment before treatment Treatment options Allogeneic HCT is a good option for you, and a well-matched donor is available ª • Allogeneic HCT • Azacitidine or decitabine followed by allogeneic HCT • High-intensity chemo followed by allogeneic HCT Allogeneic HCT may be a good option for you, but a well-matched donor is not available ª • Azacitidine (preferred) • Decitabine • Clinical trial Allogeneic HCT is not a good option for you, or a well-matched donor is not available ª • Azacitidine (preferred) • Decitabine • Clinical trial

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