New Biological Insights and Recent Therapeutic Advances in the Management of Acute and Chronic Leukemias and Myelodysplastic SyndromesDiscontinuation of azacitidine therapy for patients with MDS and worsening cytopenia
1:41 minutes.
TRANSCRIPTION:
DR SMITH: There’s a typical pattern that we’ve all seen and associate with response. You have cytopenias related to drug in the next couple of weeks, and you slowly recover. And I call it ratcheting up, each cycle you’re getting a little bit better and moving that direction, you say, “Those cytopenias are tolerated.” When you don’t ratchet up or when your cytopenias seem to be worse after 2 or 3 cycles than they were when you started, that makes me anxious that the disease is progressing. When I see really, really deep cytopenias after a cycle or two, I worry that the dose may be very — it’s a little bit too high for the patient if I’m seeing pancytopenia related to them. People out in the community are getting a single-agent drug. That’s what they have available to them. They’re treating these folks. And after 4 or 6 cycles, they’re scratching their head and saying, “Doug, what do we do? Do we switch to the alternative, the cousin demethylating drug? Do we add something to it?” I’ve been generally disappointed with both of those approaches from the standpoint of you pick up a few people who’ll respond if you switch your demethylating drug. I’ve been most impressed in the Phase II studies, that combinations at the beginning have shown some great interest. And adding something 4 or 6 or 8 cycles in hasn’t seemed to right the ship or change improvements to the demethylating drug alone. So this scenario is the one that we face a lot as consultants and as primary treaters. I like to fall back on a clinical trial, but I’m not sure which even the best clinical trial would be for these folks. |