Challenges of MDS Management

Rami Komrokji, MD: The importance of the diagnosis is related to what I asked you to talk about. It’s like the challenge and the management of MDS [myelodysplastic syndromes] patients as we discussed. They are a very heterogeneous group. If you can talk about what that accurate diagnosis and risk stratification will be doing to the management of the patient. There is not 1 treatment for every patient.

Amy DeZern, MD, MHS: That’s probably the understatement of the year. I completely agree. We’ve talked a lot about the thorough diagnostics that are required because I actually think 1 of the largest challenges early in a patient’s disease course is understanding the disease biology to the best of our ability with current techniques. A great deal of the bedside management of myelodysplastic syndrome is expectation management. These are patients who we’ve given a chronic disease diagnosis, who can take—back to that heterogeneity—quite a few varied paths over their lifetimes. We’ll talk in a minute about risk stratification, but most patients who hear that they have MDS come to see somebody at a tertiary referral center, perhaps like you or me, naturally believe they have high-risk disease and the end is coming next week. That’s certainly not always true.

I try to spend some time helping them understand the way in which their 3 cell lines may differ from normal and then how we manage each of them differently—perhaps neutropenia, anemia, thrombocytopenia—and work through how to incorporate their other potential comorbidities. The median age at diagnosis is in the late 60s, early 70s. These are people who have accumulated a lifetime of other medical issues. At least in my practice, you can tell me your experience, but I have found that, unfortunately, all of a sudden the triage list—no matter what—puts MDS way ahead of everything else. Suddenly we’re not managing the blood pressure, not following the blood sugars, this, that, and the other. This is a chronic diagnosis for even higher-risk patients, and we need to make sure the whole patient’s body stays as healthy as possible, and that’s after expectation management.

For me, the largest challenge is to make sure that while we focus on appropriate surveillance and treatment of the myelodysplastic syndrome, all the other medical comorbidities continue to get appropriate attention. So whenever we need to intervene, whether it’s next week or 5 years from now for MDS, the patient is in the best possible health to receive whatever intervention we think they need. Sometimes these other medical comorbidities complicate the therapy for MDS.

Transcript edited for clarity.