VIDEO: Understanding complications of myelodysplastic syndrome

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Probably the most critical complication in MDS, which is both related to disease but can often be worsened by therapy, are the cytopenias, particularly neutropenia and thrombocytopenia, to an extent anemia. I mean, really, almost all of the morbidity and mortality of the disease are tied to these things, so really infectious complications overall being really the most common cause of death, and so any time we can worsen that, I think that is a big thing. I think in general, again, we're hoping for our first doublet in MDS, but we're going to triplets and other things like that, is really those first months of treatment are extremely critical, and I think, although we had a historical paradigm where these patients may kind of come in periodically, we don't really think about reassessing disease till six months, let's say, of azacitidine therapy, that paradigm has disappeared, and so when we think about combination drugs, they need at least weekly, twice weekly labs. They need first month bone marrow biopsies. They need a lot of tweaking and titration and support, both for antimicrobial prophylaxis, potentially GCSF support, really close community academic collaborations. These patients are quite heterogeneous but can be quite sick, and I think, with all of that, I really am optimistic that we can really significantly improve the outcome of these patients, but these are really these complications that are most relevant.

In the lower risk MDS space, these can also be key. I think we have even a higher threshold focusing on safety in that patient group, and so those are probably the key toxicities that I think clinicians need to think about. Obviously, there can be unique side effects of individual therapies, and just the MDS group in general can have a lot of comorbidities or can have associated complications like immune diseases that may factor in, and just thinking what is related and not related, I think MDS can really, unfortunately, affect the whole body through a number of different avenues.