Treatment Guidelines

The U.S. National Comprehensive Cancer Network® (NCCN) Panel for MDS Practice Guidelines has established a recommended strategy for treating patients with myelodysplastic syndromes (MDS). The strategy uses an algorithm that takes into account the patient’s age, IPSS prognostic subgroup categorization (low, intermediate 1 and 2, and high), and performance status.1

The aim of this approach is to facilitate customized treatment plans that balance risks with therapeutic options. For instance, whether patients receive low- or high-intensity therapy will be determined by their IPSS risk score and the variables in the algorithm.1

From this approach, Peter Greenberg* and colleagues have asserted useful guidelines for treating patients with MDS:

• Stratifying patients as younger or older than age 60 helps guide treatment recommendations since this is the typical age used for eligibility for some intensive therapies, especially bone marrow transplantation (BMT).1

• Low-intensity therapy typically is appropriate for patients in the low-risk group and first intermediate-risk group.1

• High-intensity therapy is appropriate for patients in the second intermediate-risk group and high-risk group, provided the patients want the treatment and have satisfactory performance status.1

• MDS patients should be followed for 4-6 weeks when determining their clinical stability. Patients who are unstable and showing declining blood counts should be re-evaluated, and the new evaluation should include a bone marrow study.1

• Patients who remain in the low-risk group and have good performance status should receive low-intensity therapy, BMT, rAML (resistant-type acute myeloid leukemia) induction with BMT at remission, and supportive care.1

• Patients in the low-risk group who have poor performance status and/or are older than age 60 should receive low-intensity therapy and supportive care.1

• Patients in the second intermediate-risk group or high-risk group who are younger than age 60 and have good performance status should receive BMT, rAML induction with BMT at remission, low-intensity therapy, and supportive care.1

• Patients in the second intermediate-risk group or high-risk group who are older than age 60 and have good performance status should receive low-intensity therapy and rAML induction with postinduction therapy at remission.1

• Patient who are older than age 60 and have poor performance status should receive supportive care and low-intensity therapy.1

* Professor of Medicine, Hematology Division, Stanford University Medical Center, Stanford, CA; and Head, Hematology Section, Palo Alto VA Health Care System, Palo Alto, CA.