Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:17

1032 Myelodysplastic Syndrome

Contraindications to SCT for MDS

■Age >65, poor performance status, lack of suitable donor, significant

pulmonary, renal, cardiac or hepatic dysfunction. Patients with suit-

able donors who are not candidates for conventional SCT may be

considered for non-myeloablative transplantation protocols.

follow-up

During Treatment

■Monitor patients treated with 5-azacytidine, lenalidomide, erythro-

poietin or G-CSF for evidence of hematologic response.

Routine

■Off-protocol patients: monitor CBC to determine transfusion

requirement for PRBC and/or platelets. Attentive monitoring and

patient education for signs and symptoms of infection, especially in

neutropenic patients.

■For frequent PRBC, monitor for iron overload (Fe, TIBC, ferritin; con-

sider MRI liver; definitive test=liver biopsy); treat overload with

desferroxamine chelation.

complications and prognosis

■Pancytopenia: morbidity and/or mortality from infection, bleeding

■Progression to AML: morbidity and/or mortality from refractory

AML, complications of chemotherapy.

■International Prognostic Scoring System (IPSS). 4 risk categories that

correlate with survival: Low, Intermediate-1, Intermediate-2, High

Score Value

■Points:

➣0 for marrow blasts <5%, good karotype*, 0 or 1 cytopenias

➣0.5 for marrow blast 5–10%, intermediate karotype*, 2 or 3 cyto-

penias

➣1.0 for poor karyotype*

➣1.5 for marrow blasts 11–20%

➣2.0 for marrow blasts 21–30%

■*Good: normal, -Y, del(5q), del(20q); Poor: complex (>3), any chro-

mosome 7 abnormality; Intermediate: any other abnormality

■#Hemoglobin <10 g/dl; Absolute neutrophil count <1,500/mi;

Platelets <100,000/mI

■SCORE: Low=0; Intermediate-1=0.5–1.0; Intermediate-2=1.5–

2.0; High≥2.5