How Do Clinicians Choose Pharmacotherapy for Lower-Risk MDS?

A roundtable discussion, moderated by Amer Zeidan, MBBS, MHS, of Yale University, focused on the latest updates in the care of myelodysplastic syndromes (MDS). The panel included Jamie Koprivnikar, MD, of Hackensack University Medical Center; David Swoboda, MD, of Tampa General Hospital; and Sangeetha Venugopal, MD, MS, of the Sylvester Comprehensive Cancer Center in Miami.

During this discussion, Dr. Zeidan named several different types of agents that are now available to manage lower-risk MDS. He asked Dr. Koprivnikar how she chooses from the various options and which patient or disease factors she considers.

According to Dr. Koprivnikar, she would consider immunosuppressive therapy such as antithymocyte globulin plus cyclosporine for patients with hypoplastic MDS. However, she avoids using thrombopoietin mimetics in patients who have definite MDS.

“In aplastic anemia, I do tend to treat them with triple immunosuppressive therapy. Although, that’s a matter of debate as well,” she added.

Regarding hypomethylating agents, Dr. Koprivnikar said that the availability of oral versions of these drugs makes them easier to use in patients with low-risk MDS.

“I generally would reserve these agents for patients who either have an erythropoietin level of greater than 500 or who have tried and failed available options like erythropoietin-stimulating agents and luspatercept,” she said.