NCCN Guidelines for Patients® | Myelodysplastic Syndromes

50 NCCN Guidelines for Patients ® : Myelodysplastic Syndromes, 2018 5 Treatment guide Treatment for anemia Guide 11 shows the treatment options for anemia that is causing symptoms. The options differ based on the features of the MDS cells and the level of EPO in your blood. The amount of natural EPO in your blood is called the serum EPO level. One key feature is whether or not the MDS cells are missing part of chromosome 5. This chromosome change is called del(5q). Another key feature is the amount of ring sideroblasts found in the bone marrow. If MDS cells have the del(5q) chromosome change, treatment with lenalidomide may be recommended. But, this drug should not be given if you have an abnormal chromosome 7, or a very low number of neutrophils or platelets. Your doctors will give tests during treatment to check your blood cell counts. These tests are also used to check how well treatment is working. An outcome or improvement caused by treatment is called a treatment response. The goal is to increase red blood cell counts and lessen the need for red blood cell transfusions. Doctors often assess the response about 2 to 4 months after the start of treatment with lenalidomide. If tests show a response, you should continue this treatment until it stops working or side effects get too severe. Over time, your doctor may lower the dose of lenalidomide to lessen the side effects. (See page 33 for more details about lenalidomide.) Guide 11. Treatment for anemia that is causing symptoms Test results Treatment options Response and next options del(5q) ± one other chromosome change ª • Lenalidomide ª • If response, stay on lenalidominde • If no response, see Guide 5 Serum EPO ≤500 mU/mL, and <15% ring sideroblasts ª • Epoetin alfa • Darbepoetin alfa ª • If response, stay on treatment and lower the dose if needed • If no response, consider adding G-CSF or lenalidomide, then see Guide 5 if needed Serum EPO ≤500 mU/mL, and ≥15% ring sideroblasts ª • Epoetin alfa + G-CSF • Darbepoetin alfa + G-CSF ª • If response, stay on treatment and lower the dose if needed • If no response, see Guide 5 Serum EPO >500 mU/mL ª • See options in Guide 5

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