NCCN Quick Guide™ | Myelodysplastic Syndromes

2 of 2 NCCN QUICK GUIDE tm Myelodysplastic Syndromes, 2018 PAT-N-1007-1017 NCCN.org - for Clinicians | NCCN.org/patients - for Patients DONATENOW nccnfoundation.org The NCCN QUICK GUIDE tm series and NCCN Guidelines for Patients ® are supported by charitable donations made to the NCCN Foundation ® . For more details and the full library of patient and caregiver resources, visit NCCN.org/patients. What are the initial treatment options for lower-risk MDS? With anemia With del(5q) ± other chromosome changes : „„ Lenalidomide No del(5q) ± other chromosome changes and serum EPO ( e rythro po ietin) ≤500 mU/mL: „„ Epoetin alfa or darbepoetin alfa ± G-CSF ( g ranulocyte c olony- s timulating f actor) No del(5q) ± other chromosome changes and serum EPO >500 mU/mL: „„ ATG ( a nti t hymocyte g lobulin, equine) + cyclosporine „„ Azacitidine or decitabine „„ Consider lenalidomide „„ Clinical trial 42 Without anemia „„ Azacitidine or decitabine „„ IST ( i mmuno s uppressive t herapy) for certain patients „„ Clinical trial 45 What are the next treatment options for lower-risk MDS? With anemia Depending on prior treatment, options may include: 44 „„ Lenalidomide + epoetin alfa ± G-CSF „„ Lenalidomide + darbepoetin alfa ± G-CSF „„ Azacitidine or decitabine „„ Consider lenalidomide „„ Clinical trial „„ Consider allogeneic HCT ( h ematopoietic ce ll t ransplant) for certain patients Without anemia „„ Clinical trial „„ Consider allogeneic HCT for certain patients 45 What are the treatment options for higher-risk MDS? Initial treatment If allogeneic HCT is a good option and a donor is available: „„ Allogeneic HCT „„ Azacitidine or decitabine followed by allogeneic HCT „„ High-intensity chemo followed by allogeneic HCT If allogeneic HCT is a good option but a donor is not available: „„ Azacitidine (preferred) or decitabine „„ Clinical trial If allogeneic HCT is not a good option or a donor is not available: „„ Azacitidine (preferred) or decitabine „„ Clinical trial 46 Next options Depending on prior treatment, options may include: 48 „„ Consider second HCT or DLI ( d onor l ymphocyte i nfusion) „„ Azacitidine or decitabine „„ Clinical trial „„ Supportive care only NCCN Guidelines for Patients ® Page Number Ü

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