_____________________________________________________________ Thalidomide Thalidomide starting at 100 mg PO QD & increase to 400 mg as tolerated. REF= Blood 2001 Aug 15;98(4):958-65 RR 19% of patients (16 of 83). When only evaluable patients were analyzed, 31% (16 of 51) responded. It was concluded that thalidomide, as a single agent, is effective in improving cytopenias of some MDS patients, especially those who present without excess blasts _____________________________________________________________ FLAG Regimen (High-Risk MDS) Induction: FAMP 30 mg/m2 over 30 min IV DAYS 1-5 3.5 hours after completing each day?AMP infusion,ARA-C 2 g/m2 i.v. over 4 hours. GCSF 300 ug i.v. over 2 hours QD DAY 0-until CR If PR, give a second course of FLAG Consolidation: Idarubicin (IDA) 10 mg/m2 DAYS 1-2 ARA-C, 2 g/m2 DAYS 1-2 BMT if Age<60 No further treatment if age>60 No one >74 years of age treated with FLAG CR 90% age<60, 53% age>60 Ref: Cancer 86, Issue 10: 2006-2013,1999 Br J Haematol 1997; 99: 939-44 Leuk Res 1997; 21(Suppl 1): 48a _____________________________________________________________ TOPOTECAN + ARA-C This regimen is still fairly toxic! _____________________________________________________________ Others..... SubQ Ara-C AMIFOSTINE _____________________________________________________________
____________________________________________ MDS SUBTYPES: REFRACTORY ANEMIA <1% PB blasts; <5%BM blasts; <15% sideroblasts; +dysopoiesis REFRACTORY ANEMIA WITH RINGED SIDEROBLASTS <1% PB blasts; <5%BM blasts; >15% sideroblasts; +/-dysopoiesis REFRACTORY ANEMIA WITH EXCESS BLASTS <5% PB blasts; 5-20%BM blasts; variable% sideroblasts; ++dysopoiesis REFRACTORY ANEMIA WITH EXCESS BLASTS IN TRANSFORMATION >5% PB blasts; 20-30%BM blasts; variable% sideroblasts; variable% monos; ++dysopoiesis CMML >10e9 monos; 1-20%BM blasts; variable% sideroblasts; Increased monos; ++dysopoiesis ____________________________________________
|