Low risk prognoses

The U.S. National Comprehensive Cancer Network^® (NCCN) has established practice guidelines for treating all patients with MDS. MDS patients with an IPSS prognosis of Low or INT-1 risk frequently experience a more indolent course to their disease. Prognoses generally include longer survival times and lengthened times to AML transformation when compared to MDS patients with higher-risk disease. Using NCCN practice guidelines, treatment for low risk patients generally relies on low intensity therapeutic approaches. Low intensity treatments include approved therapy, cytotoxic and non-cytotoxic therapies, investigational treatments administered within a clinical trial, as well as immunomodulatory therapies, with adjuvant supportive care used in conjunction with any approach.

• Initial treatment decisions should begin with observation and monitoring with the purpose of establishing an indolent or progressive disease course
• At this early stage, monitoring of the relative stability or instability of cell counts, transfusion requirements, and number of infections should be initiated to establish a persistence of Low to INT-1 risk disease or a transition toward INT-2 or High risk MDS
• Age (≤60 years or >60 years), ECOG performance status, and the presence or absence of comorbidities are essential in establishing a treatment plan

Stable Disease

• Generally, low risk patients with stable cell counts, transfusions, and infections should be treated with low intensity therapy including approved therapy and supportive care
• Low risk patients with poor ECOG performance status should receive supportive care only regardless of stable or declining cell counts, increased transfusion needs, and/or repeated infections
• Low risk patients with stable counts and INT-1 risk disease may also be considered for stem cell transplantation protocols

Unstable Disease

Low-risk MDS patients with unstable disease including declining cell counts, increased transfusion requirements, and/or repeated infections should be reassessed, using bone marrow aspiration, iron stain, biopsy, and a cytogenetic workup.

• Age and performance status are essential in developing a treatment plan
• Patients >60 years of age with good performance status, who, despite unstable counts, persist at low or INT-1 IPSS risk levels, should receive low intensity therapy, including approved therapy, and supportive care
• Patients ≤60 years of age persisting at low or INT-1 MDS should receive low intensity treatment, including approved therapy and supportive care, or high intensity therapy
• Patients whose assessments suggest transition to higher risk MDS are recommended to receive low intensity therapy, including approved therapy and supportive care of high intensity treatment, including:
  • cytoxic or non-cytotoxic therapies
  • standard induction regimens which may lead to HSCT
  • reduced-intensity conditioning with non-myeloablative transplantation regimens

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INT-1 risk prognoses

The U.S. National Comprehensive Cancer Network^® (NCCN) has established practice guidelines for treating all patients with MDS. MDS patients with an IPSS prognosis of Low or INT-1 risk frequently experience a more indolent course to their disease. Prognoses generally include longer survival times and lengthened times to AML transformation when compared to MDS patients with higher-risk disease. Using NCCN practice guidelines, treatment for low risk patients generally relies on low intensity therapeutic approaches. Low intensity treatments include approved therapy, cytotoxic and non-cytotoxic therapies, investigational treatments administered within a clinical trial, as well as immunomodulatory therapies, with adjuvant supportive care used in conjunction with any approach.

• Initial treatment decisions should begin with observation and monitoring with the purpose of establishing an indolent or progressive disease course
• At this early stage, monitoring of the relative stability or instability of cell counts, transfusion requirements, and number of infections should be initiated to establish a persistence of Low to INT-1 risk disease or a transition toward INT-2 or High risk MDS
• Age (≤60 years or >60 years), ECOG performance status, and the presence or absence of comorbidities are essential in establishing a treatment plan

Stable Disease

• Generally, low risk patients with stable cell counts, transfusions, and infections should be treated with low intensity therapy including approved therapy and supportive care
• Low risk patients with poor ECOG performance status should receive supportive care only regardless of stable or declining cell counts, increased transfusion needs, and/or repeated infections
• Low risk patients with stable counts and INT-1 risk disease may also be considered for stem cell transplantation protocols

Unstable Disease

Low-risk MDS patients with unstable disease including declining cell counts, increased transfusion requirements, and/or repeated infections should be reassessed, using bone marrow aspiration, iron stain, biopsy, and a cytogenetic workup.

• Age and performance status are essential in developing a treatment plan
• Patients >60 years of age with good performance status, who, despite unstable counts, persist at low or INT-1 IPSS risk levels, should receive low intensity therapy, including approved therapy, and supportive care
• Patients ≤60 years of age persisting at low or INT-1 MDS should receive low intensity treatment, including approved therapy and supportive care, or high intensity therapy
• Patients whose assessments suggest transition to higher risk MDS are recommended to receive low intensity therapy, including approved therapy and supportive care of high intensity treatment, including:
  • cytoxic or non-cytotoxic therapies
  • standard induction regimens which may lead to HSCT
  • reduced-intensity conditioning with non-myeloablative transplantation regimens

INT-2 risk prognoses

The U.S. National Comprehensive Cancer Network^® (NCCN) has established practice guidelines for treating patients with MDS. Their guidelines recommend that treatment plans for higher-risk MDS should include currently approved therapy, high or low intensity therapies, as well as investigational treatments, including cytotoxic or non-cytotoxic therapies, standard induction regimens which may lead to HSCT, or reduced-intensity conditioning with non-myeloablative transplantation regimens through clinical trials. Adjuvant supportive care should be used with any approach. Treatment strategies are based on patient age (≤60 years or >60 years), ECOG performance status, as well as the presence or absence of co-morbidities.

High risk prognoses

The U.S. National Comprehensive Cancer Network^® (NCCN) has established practice guidelines for treating patients with MDS. Their guidelines recommend that treatment plans for higher-risk MDS should include currently approved therapy, high or low intensity therapies, as well as investigational treatments, including cytotoxic or non-cytotoxic therapies, standard induction regimens which may lead to HSCT, or reduced-intensity conditioning with non-myeloablative transplantation regimens through clinical trials. Adjuvant supportive care should be used with any approach. Treatment strategies are based on patient age (≤60 years or >60 years), ECOG performance status, as well as the presence or absence of co-morbidities.