Lower-Risk MDS

Management - anemia

EPO

• relatively high dose, e.g. 60,000u EPO q7d, 500 μg darbepoetin alfa q21d
• meta-analysis: ~40% response rate overall (hgb up 1-1.5g, reduction in tfx)
• 2017 RCT: 15% RR at 24wk (0% in placebo)
  • Open-label 48wk f/u: 35% RR
• response rate is higher if lower baseline EPO (e.g.<200 IU/L)
  • if high tfx dependence (≥1 tfx/14d) and EPO >200, RR <10%
• mean duration of response: 8-23mo
• fever in 10%