NCCN Guidelines for Patients® | Myelodysplastic Syndromes
48 NCCN Guidelines for Patients ® : Myelodysplastic Syndromes, 2018 5 Treatment guide Higher-risk MDS Guide 9. Next treatment options for higher-risk MDS Prior treatment Results Treatment options Next options • Allogeneic HCT • Azacitidine or decitabine followed by allogeneic HCT • High-intensity chemo followed by allogeneic HCT ª • Relapse after HCT or no response ª • Consider second HCT or DLI • Azacitidine or decitabine • Clinical trial ª • If response, continue treatment • If relapse or no response, clinical trial or supportive care • Azacitidine (preferred) • Decitabine • Clinical trial ª • Response ª • Continue treatment until it stops working • Relapse or no response ª • Clinical trial • Supportive care Guide 9 shows the next options used after initial treatment for higher-risk MDS. There are several options to choose from. Which option is best for you depends on which treatment you had before and how well it worked. Your doctor will give tests during treatment to check how well it’s working. An outcome or improvement caused by treatment is called a treatment response. How long it takes to see a treatment response depends on the type of treatment used. A relapse is the return or worsening of MDS after a response or period of improvement. If you had an allogeneic HCT, and tests show a relapse or no response, there are three main options to choose from. The first option is to have a second allogeneic HCT or a DLI. This may be a good option if the response to the first HCT lasted for a while before tests showed a relapse. The second option is to receive azacitidine or decitabine. Both are low-intensity chemotherapy drugs. They are a lot alike in how they work against MDS. With either drug, treatment should be continued as long as it is working well. The third option is to join a clinical trial. If any of these treatments don’t work or stop working, there are two more options to choose from. One option is to receive a different treatment within a clinical trial. Another option is to receive supportive care only. If you had azacitidine or decitabine, the next options depend on how well the drug worked. With either drug, at least 4 to 6 cycles should be given before checking for a response. If tests show a response, then treatment should be continued as long as it keeps working.