Welcome to Managing MDS, I am Dr. Eunice Wang. Today I will be discussing how one can determine when an MDS patient is failing hypomethylating therapy and needs a different treatment. In general, patients that receive hypomethylating agents for treatment of their MDS are high-risk IPSS or IPSS-R patients. These patients have been shown to clearly benefit from hypomethylating agents, with significant improvements in hematologic parameters and decreases in the need for transfusions as well as growth factor support. However, when patients start developing progressive cytopenias, or when they’ve received several cycles of hypomethylating therapy and they become transfusion dependent again, that’s when hypomethylating therapy failure needs to be considered. These are patients that over time, over several cycles, start to lose their hematologic parameters, or they start to develop evidence of AML progression with peripheral blasts and other concerning complications from developing cytopenias. It is at this point that consideration for other therapies need to be entertained, and the primary consideration at this point would be when to stop the hypomethylating agents, and to move on either to investigational therapies or referral for stem cell transplantation.
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