MANAGEMENT MINUTE EPISODES AND TRANSCRIPTS
This is Mikkael Sekeres from the Sylvester Comprehensive Cancer Center at the University of Miami presenting your Management Minute for Figure 1 on myelodysplastic syndromes at the ASH annual meeting.
This year we saw presentations from Nathan Radakovich and Dr. Nazha’s group looking at personalized prediction models of patients who are more likely to respond to hypomethylating agents, and for overall survival.
We also saw a great abstract from Dr. Itzykson and his group looking at decitabine versus hydroxyurea in chronic myelomonocytic leukemia, showing that there is actually no advantage to decitabine over hydroxyurea.
I had a presentation looking at the efficacy of pevonedistat and azacitidine versus azacitidine alone, showing an improvement in event-free survival for patients receiving the combination versus azacitidine monotherapy.
And Dr. Garcia from MD Anderson showed impressive results for venetoclax and azacitidine in patients with myelodysplastic syndrome.
Presented by Mikkael Sekeres, MD, MS
Chief of the Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami
Get the latest clinical insights in hematology-oncology from Dr. Mikkael Sekeres in our twice-monthly newsletter, The Differential: Hematology.
Hi everybody. I’m Mikkael Sekeres and I’m here to talk about lower-risk myelodysplastic syndromes.
When we talk about risk with myelodysplastic syndromes, we use as a default staging system the International Prognostic Scoring System, or IPSS. For patients with lower-risk disease, these folks would have relatively few cytopenias, so maybe an isolated anemia. They would have relatively good risk cytogenetics, so maybe normal cytogenetics or deletion 5q, deletion 20q, or -Y, and they would have relatively few blasts, in other words, fewer than 5% blasts.
We treat these patients based on which cytopenia is predominating at the time. If a person has anemia, we might approach them with erythropoiesis stimulating agents or luspatercept. Somebody with thrombocytopenia, we might use thrombopoietin mimetics, such as romiplastin and eltrombopag. And patients with multiple cytopenias, we would treat with hypomethylating agents.
Hi everybody. I’m Mikkael Sekeres and I’m here to talk with you about higher-risk myelodysplastic syndromes.
When we talk about risk in myelodysplastic syndromes, we use as a default staging system the International Prognostic Scoring System, or IPSS. Patients with higher-risk disease under the IPSS may have multiple cytopenias, so anemia and neutropenia, or anemia and thrombocytopenia. They would have poor-risk cytogenetics, so either complex or abnormalities of chromosome 7, and they usually have a high blast percentage, 5-19%, where, of course, 20% would define patients as having acute myeloid leukemia.
We usually treat these patients with hypomethylating agents, such as azacitidine, decitabine, or the new oral decitabine, with azacitidine being the only one of those drugs that has shown a survival benefit in a prospective trial. And we offer bone marrow transplantation at diagnosis, as this is the only type of cure for MDS.
Get the latest clinical insights in hematology-oncology from Dr. Mikkael Sekeres in our twice-monthly newsletter,
The Differential: Hematology.