NCCN Guidelines for Patients® | Myelodysplastic Syndromes
51 NCCN Guidelines for Patients ® : Myelodysplastic Syndromes, 2018 5 Treatment guide Treatment for anemia For patients with serum EPO ≤500 mU/mL, treatment with blood cell growth factors is recommended. The two main options are epoetin alfa and darbepoetin alfa. Both drugs are red blood cell growth factors— also called ESAs. ESAs are drugs that act like EPO, a substance that is made naturally in your body to stimulate the growth of new red blood cells. Thus, these drugs work best when there is a lower level of natural EPO in the blood. If less than 15 percent of cells in the bone marrow are ring sideroblasts, then ESAs alone are suggested. If 15 percent or more of the bone marrow cells are ring sideroblasts, then G-CSF should be given along with an ESA. G-CSF is a white blood cell growth factor. Studies show that adding G-CSF can improve how well ESAs work for some patients. Epoetin alfa is given in high doses weekly. Darbepoetin alfa is a long-acting drug and is given once every 2 weeks. Low doses of G-CSF are given weekly. (See page 29 for more details about blood cell growth factors.) The goal of treatment with blood cell growth factors is to increase red blood cell counts and hemoglobin level and decrease the number of red blood cell transfusions needed. This often happens 6 to 8 weeks after the start of treatment. If the treatment works, it should be continued. If treatment with an ESA alone isn’t working well, then G-CSF may be added. If these drugs do not improve your hemoglobin level within several months, they should be stopped and other treatment should be tried. Your doctor will give tests during treatment to check how well it’s working. If tests show a treatment response, treatment should be continued until it stops working. Over time, lower doses may be given based on the treatment response. For patients with serum EPO >500 mU/mL, treatment with red blood cell growth factors is not recommended. EPO is made naturally in your body to stimulate your bone marrow to make more red blood cells. Red blood cell growth factors are drugs that act like EPO. These drugs don’t work as well when there is a higher level of natural EPO in the blood. Therefore, other types of treatments should be used. Next steps If tests don’t show a treatment response, or treatment stops working, see Guide 5 on page 42 for more treatment options. Guide 5 also includes treatment options for patients with serum EPO >500 mU/mL.