Article

Treatment of Myelodysplastic Syndromes

Sandra Kurtin

Erin P. Demakos

Janet Hayden

Claudia Boglione

myeloproliferative disorders, Patient education, geriatric nursing, Assessment
CJON 2012, 16(3), 23-35. DOI: 10.1188/12.CJON.S1.23-35

Myelodysplastic syndromes (MDS) are a heterogeneous group of myeloid malignancies with variability in clinical presentation, disease trajectory, treatment goals, and expected outcomes. The treatment of patients with MDS, therefore, often differs from patient to patient. Tools are needed to aid effective communication with patients, their caregivers, and their dedicated team of healthcare professionals. The use of methods often employed in clinical trials can help healthcare providers diagnose and classify risk status, track trends within patient responses, manage adverse events, set treatment expectations, and provide ongoing supportive care. This article discusses several tools and strategies available for the management of patients with MDS throughout the continuum of their disease.

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    References

    Bejar, R., Levine, R., & Ebert, B. L. (2011). Unraveling the molecular pathophysiology of myelodysplastic syndromes. Journal of Clinical Oncology, 29, 504-515. doi:10.1200/JCO.2010.31.1175
    Catenacci, D. V., & Schiller, G. J. (2005). Myelodysplastic syndromes: A comprehensive review. Blood Reviews, 19, 301-319. doi:10.1016/j.blre.2005.01.004
    Celgene Corporation. (2009). Revlimid® (lenalidomide) [Prescribing information]. Retrieved from http://www.revlimid.com/docs/Revlimid-Full-PI.pdf
    Celgene Corporation. (2011). Vidaza® (azacitidine) [Prescribing information]. Retrieved from http://www.vidaza.com/pdf/PI_FINAL.pdf
    Cheson, B. D., Greenberg, P. L., Bennett, J. M., Lowenberg, B., Wijermans, P. W., Nimer, S. D., … Kantarjian, H. (2006). Clinical application and proposal for modification of the International Working Group (IWG) response criteria in myelodysplasia. Blood, 108, 419-425. doi:10.1182/blood-2005-10-4149
    Fenaux, P., Giagounidis, A., Selleslag, D., Beyne-Rauzy, O., Mufti, G. J., Mittelman, M., … Hellstrom-Lindberg, E. (2009). RBC transfusion independence and safety profile of lenalidomide 5 or 10 mg in patients with low- or int-1 risk MDS with del5q: Results from a randomized phase II trial (MDS-004) [Abstract 944]. Blood, 114, 390.
    Fenaux, P., Mufti, G. J., Hellstrom-Lindberg, E., Santini, V., Finelli, C., Giagounidis, A., … International Vidaza High-Risk MDS Survival Study Group. (2009). Efficacy of azacitidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: A randomised, open-label, phase III study. Lancet Oncology, 10, 223-232. doi:10.1016/S1470-2045(09)70003-8
    Garcia-Manero, G. (2010). Prognosis of myelodysplastic syndromes. Hematology/The American Society of Hematology Education Program, 330-337. doi:10.1182/asheducation-2010.1.330
    Greenberg, P., Cox, C., LeBeau, M. M., Fenaux, P., Morel, P., Sanz, G., … Bennett, J. (1997). International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood, 89, 2079-2088.
    Greenberg, P., Tuechler, H., Schanz, J., Sole, F., Bennett, J. M., Garcia-Manero, G., … Haase, D. (2011). Revised International Prognostic Scoring System (IPSS-R), developed by the International Working Group for Prognosis in MDS (IWG-PM) [Abstract 14]. Leukemia Research, 35(Suppl. 1), S6.
    Harvey, R. D. (2010). Myelodysplastic syndromes and the role of iron overload. American Journal of Health-System Pharmacy, 67(7, Suppl. 2), S3-S9. doi:10.2146/ajhp090645
    Hershko, C. (2005). Treating iron overload: The state of the art. Seminars in Hematology, 42(2, Suppl. 1), S2-S4.
    Jadersten, M., Saft, L., Smith, A., Kulasekararaj, A., Pomplun, S., Gohring, G., … Mufti, G. J. (2011). TP53 mutations in low-risk myelodysplastic syndromes with del(5q) predict disease progression. Journal of Clinical Oncology, 29, 1971-1979. doi:10.1200/JCO.2010.31.8576
    Jansen, A. J., Essink-Bot, M. L., Beckers, E. A., Hop, W. C., Schipperus, M. R., & Van Rhenen, D. J. (2003). Quality of life measurement in patients with transfusion-dependent myelodysplastic syndromes. British Journal of Haematology, 121, 270-274.
    Kantarjian, H., Issa, J. P., Rosenfeld, C. S., Bennett, J. M., Albitar, M., DiPersio, J., … Saba, H. (2006). Decitabine improves patient outcomes in myelodysplastic syndromes: Results of a phase III randomized study. Cancer, 106, 1794-1803. doi:10.1002/cncr.21792
    Komrokji, R. S., Sekeres, M. A., & List, A. F. (2011). Management of lower-risk myelodysplastic syndromes: The art and evidence. Current Hematologic Malignancy Reports, 6, 145-153. doi:10.1007/s11899-011-0086-x
    Komrokji, R. S., Zhang, L., & Bennett, J. M. (2010). Myelodysplastic syndromes classification and risk stratification. Hematology/Oncology Clinics of North America, 24, 443-457. doi:10.1016/j.hoc.2010.02.004
    Kurtin, S. (2010). Risk analysis in the treatment of hematological malignancies in the elderly. Journal of the Advanced Practitioner in Oncology, 1, 119-129.
    Kurtin, S. (2011a). Current approaches to the diagnosis and management of myelodysplastic syndromes. Journal of the Advanced Practitioner in Oncology, 2(Suppl. 2), 7-18.
    Kurtin, S. (2011b). Leukemia and myelodysplastic syndromes. In C. H. Yarbro, D. Wujcik, & B. H. Gobel (Eds.), Cancer nursing: Principles and practice (7th ed., pp. 1369-1398). Sudbury, MA: Jones and Bartlett.
    Kurtin, S., & Demakos, W. (2011). Disease burden associated with quality of life in myelodysplastic syndromes: Findings from a Web-based survey [Abstract 354]. Leukemia Research, 35(Suppl. 1), S142.
    Kurtin, S. E. (2007). Myelodysplastic syndromes: Diagnosis, treatment planning, and clinical management. Oncology (Williston Park), 21(11, Suppl. Nurse Ed.), 41-48.
    Kurtin, S. E., & Demakos, E. P. (2010). An update on the treatment of myelodysplastic syndromes [Online exclusive]. Clinical Journal of Oncology Nursing, 14, E24-E39. doi:10.1188/10.CJON.E24-E39
    Kurtin, S. E., & List, A. F. (2009). Durable long-term responses in patients with myelodysplastic syndromes treated with lenalidomide. Clinical Lymphoma and Myeloma, 9, E10-E13. doi:10.3816/CLM.2009.n.053
    List, A., Dewald, G., Bennett, J., Giagounidis, A., Raza, A., Feldman, E., … Myelodysplastic Syndrome-003 Study Investigators. (2006). Lenalidomide in the myelodysplastic syndrome with chromosome 5q deletion. New England Journal of Medicine, 355, 1456-1465. doi:10.1056/NEJMoa061292
    List, A., Kurtin, S., Roe, D. J., Buresh, A., Mahadevan, D., Fuchs, D., … Zeldis, J. B. (2005). Efficacy of lenalidomide in myelodysplastic syndromes. New England Journal of Medicine, 352, 549-557.
    Lubbert, M., Suciu, S., Baila, L., Ruter, B. H., Platzbecker, U., Giagounidis, A., … Wijermans, P. W. (2011). Low-dose decitabine versus best supportive care in elderly patients with intermediate- or high-risk myelodysplastic syndrome (MDS) ineligible for intensive chemotherapy: Final results of the randomized phase III study of the European Organisation for Research and Treatment of Cancer Leukemia Group and the German MDS Study Group. Journal of Clinical Oncology, 29, 1987-1996. doi:10.1200/JCO.2010.30.9245
    Malcovati, L., Porta, M. G., Pascutto, C., Invernizzi, R., Boni, M., Travaglino, E., … Cazzola, M. (2005). Prognostic factors and life expectancy in myelodysplastic syndromes classified according to WHO criteria. Journal of Clinical Oncology, 23, 7594-7603.
    Naqvi, K., Garcia-Manero, G., Sardesai, S., Oh, J., Vigil, C. E., Pierce, S., … Suarez-Almazor, M. E. (2011). Association of comorbidities with overall survival in myelodysplastic syndrome: Development of a prognostic model. Journal of Clinical Oncology, 29, 2240-2246. doi:10.1200/JCO.2010.31.3353
    National Comprehensive Cancer Network. (2011a). NCCN Clinical Practice Guidelines in Oncology: Acute myeloid leukemia [v2.2011]. Retrieved from http://www.nccn.org/professionals/physician_gls/PDF/aml.pdf
    National Comprehensive Cancer Network. (2011b). NCCN Clinical Practice Guidelines in Oncology: Myelodysplastic syndromes [v2.2011]. Retrieved from http://www.nccn.org/professionals/physician_gls/PDF/mds.pdf
    Oliva, E., Dimitrov, B., D'Angelo, A., Martino, B., Perna, A., & Nobile, F. (2001). QOL-E: A new tool for the assessment of quality of life in myelodysplastic syndrome. Blood, 98, 427a.
    Price, E. A., Mehra, R., Holmes, T. H., & Schrier, S. L. (2011). Anemia in older persons: Etiology and evaluation. Blood Cells, Molecules and Diseases, 46, 159-165. doi:10.1016/j.bcmd.2010.11.004
    Pullarkat, V. (2009). Objectives of iron chelation therapy in myelodysplastic syndromes: More than meets the eye? Blood, 114, 5251-5255. doi:10.1182/blood-2009-07-234062
    Raza, A., Reeves, J. A., Feldman, E. J., Dewald, G. W., Bennett, J. M., Deeg, H. J., … List, A. F. (2008). Phase 2 study of lenalidomide in transfusion-dependent, low-risk, and intermediate-1 risk myelodysplastic syndromes with karyotypes other than deletion 5q. Blood, 111, 86-93.
    Sekeres, M. A., Maciejewski, J. P., Giagounidis, A. A., Wride, K., Knight, R., Raza, A., & List, A. F. (2008). Relationship of treatment-related cytopenias and response to lenalidomide in patients with lower-risk myelodysplastic syndromes. Journal of Clinical Oncology, 26, 5943-5949. doi:10.1200/JCO.2007.15.5770
    Sekeres, M. A., Maciejewski, J. P., List, A. F., Steensma, D. P., Artz, A., Swern, A. S., … Stone, R. (2011). Perceptions of disease state, treatment outcomes, and prognosis among patients with myelodysplastic syndromes: Results from an Internet-based survey. Oncologist, 16, 904-911. doi:10.1634/theoncologist.2010-0199
    Silverman, L. R., Fenaux, P., Mufti, G. J., Santini, V., Hellstrom-Lindberg, E., Gattermann, N., … Seymour, J. F. (2011). Continued azacitidine therapy beyond time of first response improves quality of response in patients with higher-risk myelodysplastic syndromes. Cancer, 117, 2697-2702. doi:10.1002/cncr.25774
    Spiriti, M. A., Latagliata, R., Niscola, P., Cortelezzi, A., Francesconi, M., Ferrari, D., … Petti, M. C. (2005). Impact of a new dosing regimen of epoetin alfa on quality of life and anemia in patients with low-risk myelodysplastic syndrome. Annals of Hematology, 84, 167-176. doi:10.1007/s00277-004-0961-9
    Steensma, D. P., Baer, M. R., Slack, J. L., Buckstein, R., Godley, L. A., Garcia-Manero, G., … Kantarjian, H. (2009). Multicenter study of decitabine administered daily for 5 days every four weeks to adults with myelodysplastic syndromes: The Alternative Dosing for Outpatient Treatment (ADOPT) trial. Journal of Clinical Oncology, 27, 3842-3848. doi:10.1200/JCO.2008.19.6550
    Steensma, D. P., & Stone, R. M. (2010). Practical recommendations for hypomethylating agent therapy of patients with myelodysplastic syndromes. Hematology/Oncology Clinics of North America, 24, 389-406. doi:10.1016/j.hoc.2010.02.012
    SuperGen, Inc. (2010). Dacogen® (decitabine) [Prescribing information]. Retrieved from http://us.eisai.com/pdf_files/Dacogen_PI.pdf
    Verburgh, E., Achten, R., Maes, B., Hagemeijer, A., Boogaerts, M., De Wolf-Peeters, C., & Verhoef, G. (2003). Additional prognostic value of bone marrow histology in patients subclassified according to the International Prognostic Scoring System for myelodysplastic syndromes. Journal of Clinical Oncology, 21, 273-282.