Skill Checkup: A 72-Year-Old Woman With Myelodysplastic Syndrome Presents With Persistent Anemia and Fatigue

Emmanuel C. Besa, MD


April 08, 2022

Features predictive of ESA response include a lower baseline serum EPO level (< 500 IU/mL), a low transfusion burden (< 2 units a month), a fixed-dose regimen, shorter time from diagnosis to starting treatment, and diagnosis of refractory anemia or RARS. Although the patient in the present case is in fact diagnosed with refractory anemia or RARS, response rates to ESA therapy are variable in patients with lower-risk MDS, ranging from 30%-60%.

In this patient population, close monitoring of hemoglobin level is recommended to avoid increases to > 12 g/dL (associated with a risk for systemic hypertension and thrombosis). In addition, immunomodulatory agent lenalidomide can reduce transfusion requirements in lower-risk MDS patients with a normal karyotype.


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