denotes an abstract that is clinically relevant.
denotes that this is a recommended PHD Trainee Session.
denotes that this is a ticketed session.Session: 637. Myelodysplastic Syndromes—Clinical Studies: Poster I
Hematology Disease Topics & Pathways:
Diseases, MDS, Biological Processes, Clinically relevant, Myeloid Malignancies, Quality Improvement , iron metabolism
Methods: The CCMDS, Canadian hematologists with an interest in MDS, updated IOL guidelines. Topics reviewed include mechanisms of IOL induced cellular damage, evidence for clinical endpoints impacted by IOL: organ dysfunction, infections, marrow failure, OS, AML progression, and endpoints around hematopoietic stem-cell transplant (SCT). Evidence for an impact of IOL reduction on these endpoints is discussed and areas identified where evidence is suboptimal. An internet-based algorithm, the MDS Iron Road, was developed by the CCMDS and hemoglobinopathies experts with expertise in IOL management. The algorithm addresses diagnosis, workup and management of IOL in clinical practice, and discusses treatment of IOL not only with ICT but also with MDS treatments that induce RBC transfusion independence, and practical recommendations are made. Evidence levels and grading of recommendations are provided.
Results: The Iron Road provides a step by step approach to the diagnosis, workup and management of IOL in MDS. Reference to the MDS Clear Path is provided for information on MDS diagnosis, prognostic scores and management, with details on therapeutic options. The MDS Iron Road provides in-depth discussion of RBC transfusions, IOL, and iron reduction strategies including ICT, chelators available, dosing and administration, monitoring, dose adjustments, expected response, side effects and their management, and provincial reimbursement. Where data are lacking but practical advice needed, recommendations were incorporated. The “IR Express” mode guides the user through a series of questions specific to the patient’s clinical status resulting in a treatment recommendation while the self-directed mode presents the overall algorithm with links to details. Information panels are provided throughout which discuss evidence supporting treatment recommendations. The self-directed mode is shown in Figure 1. References with links to abstracts and supportive data are included within the algorithm and information panels. An example case: A 68 year old man is referred for anemia, RBC transfusion dependent (TD), requiring 2 units per 4 weeks. He is fatigued and short of breath on exertion. A bone marrow aspirate and biopsy shows MDS-RS, IPSS intermediate-1 risk. Serum ferritin is 1800ng/mL. The recommendation is to reduce IOL. From the algorithm, he has lower-risk MDS, is not eligible for allogeneic SCT, has TD anemia, a life expectancy >1-2 years, and has documented IOL. The next question: is he eligible for therapy that induces transfusion independence? He is eligible for ESA and becomes transfusion independent, with a hemoglobin (Hb) of 115g/L. The algorithm shows that IOL can be reduced by serial phlebotomy, or by ICT if the Hb will not support phlebotomy. The Iron Road is available in English (French version pending) by entering https://mdsironroad.org into your browser. The username is ironroad and the password makeirongreatagain. If the meeting is live, an ipad will be available to demonstrate navigation of the MDS Iron Road. Feedback can be left at MDSIronRoad Feedback (Responses).
Discussion: An internet-based algorithm is available from the CCMDS to support health care providers in diagnosing and managing IOL in MDS. Recommendations from the algorithm should help to standardize IOL care in MDS across Canada. The algorithm includes indications and medications not currently approved for IOL in MDS in Canada and these are clearly identified. Content will be updated to reflect advances made in IOL care in MDS.
Disclosures: Leitch: Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; AbbVie: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Alexion: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Taiho: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Exjade: Speakers Bureau. Ezzat: Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees. Buckstein: Celgene: Honoraria; Astex: Honoraria; Novartis: Honoraria; Takeda: Research Funding; Celgene: Research Funding. Zhu: Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees. Nevill: Jazz Pharmaceuticals: Honoraria; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Alexion: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Olney: Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees. Leber: Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Otsuka Pharmaceutical: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; BMS/Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Lundbeck: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Alexion: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Treadwell: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda/Palladin: Honoraria, Membership on an entity's Board of Directors or advisory committees. Keating: Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi: Membership on an entity's Board of Directors or advisory committees; Merck: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Hoffman La Roche: Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Consultancy; Servier: Membership on an entity's Board of Directors or advisory committees; Shire: Membership on an entity's Board of Directors or advisory committees; Taiho: Membership on an entity's Board of Directors or advisory committees. St. Hilaire: Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Kumar: Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Delage: Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Geddes: Alexion: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Storring: Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Shamy: Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Elemary: Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Wells: Alexion: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.
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