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Welcome to Dr. Hamid Sanatinia's Virtual Headquarters
MDS

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Should we treat or not???
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MDR

Myelodysplastic Syndrome:
1. Chemotherapyt
2. MDS subtypes
3. IPSS

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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

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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
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TOPOTECAN + ARA-C

This regimen is still fairly toxic!
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Others.....

SubQ Ara-C
AMIFOSTINE
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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
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IPSS for MDS



Prognostic Variable Score Value
0 0.5 1.0 1.5 2.0
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BM blasts (%) <5 (0) 5-10 (0.5) 11-20 (1.5) 21-30 (2.0)
Karyotype* Good(0) Intermediate(0.5) Poor (1.0)
Cytopenias 0/1(0) 2/3(0.5)

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Scores for risk groups are as follows: Low, 0; INT-1, 0.5-1.0; INT-2, 1.5-2.0; and High, 2.5.
* Good, normal, -Y, del(5q), del(20q); Poor, complex (3 abnormalities) or chromosome 7 anomalies; Intermediate, other abnormalities.