Episode 415: Myelodysplastic Syndrome Treatment Considerations for Oncology Nurses

“We want to make sure that we discuss the details of the treatment and what treatments there are, whether it’s an oral drug, whether it’s a subcutaneous injection or an IV injection, [the patient’s] potential for responding, whether this treatment is curative or supportive, and what the number of visits are. All of those different pieces of information that go into the decision-making process are really important,” ONS member Sara Tinsley-Vance, PhD, APRN, AOCN^®, nurse practitioner and quality-of-life researcher at Moffitt Cancer Center in Tampa, FL, told Lenise Taylor, MN, RN, AOCNS^®, TCTCN^™, oncology clinical specialist at ONS, during a conversation about myelodysplastic syndrome (MDS) treatment considerations.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by May 15, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge about the treatment considerations for MDS.

Episode Notes 

• Complete this evaluation for free NCPD. 
• ONS Podcast™ episodes:
  • Episode 411: An Overview of Myelodysplastic Syndrome for Oncology Nurses
  • Episode 256: Cancer Symptom Management Basics: Hematologic Complications
• ONS Voice articles:
  • FDA Approves Luspatercept-Aamt for Anemia in Adults With MDS
  • Infection Prevention for Oncology Nurses
  • Manage Cancer-Associated Anemia With Erythropoietin-Stimulating Agents
  • Whole-Genome Sequencing May Guide Treatment Choices for AML and MDS
• Clinical Journal of Oncology Nursing articles: 
  • Reducing Effects of Hospital-Associated Deconditioning in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation
  • Resilience in Older Adults Diagnosed With Cancer and Receiving Chemotherapy
  • Targeted Drug Therapies: Beyond Blood Counts and Chemistries
• Oncology Nursing Forum article: Frailty in Patients With Hematologic Malignancies and Those Undergoing Transplantation: A Scoping Review
• ONS books:
  •  BMTCN^™ Certification Review Manual (second edition)
  • Hematopoietic Stem Cell Transplantation: A Manual for Nursing Practice (third edition)
• ONS course: Hematopoietic Stem Cell Transplantation^™
• ONS Learning Library: Hematology, Cellular Therapy, and Stem Cell Transplantation
• ONS Symptom Intervention resources:
  • Prevention of Infection: General
  • Prevention of Infection: Transplant
• Aplastic Anemia and MDS International Foundation: MDS Drugs and Treatments
• Blood Cancer United: MDS Treatment
• HealthTree Foundation
• Myelodysplastic Syndromes Foundation

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Highlights From This Episode

“The goals that I try to consolidate to make sure they’re consistent with the patient’s goals are to improve their counts, especially the anemia or cytopenias. If they’re getting blood transfusions, we want to reduce the number of transfusions that they receive because we know that’s linked to reduced overall survival, and it really impacts quality of life. ... And then for high-risk patients, it’s a more serious discussion because we know that they are the ones who can progress to acute myeloid leukemia (AML). And we’re trying to delay progression to AML. That means we’re trying to improve their survival and we’re also trying to manage their cytopenias and decrease their infection risk.” TS 2:28

“If we look at approvals for low-risk disease and high-risk disease, those were really made based on the Revised International Prognostic Scoring System (IPSS-R) and sometimes the International Prognostic Scoring System (IPSS). Under those classification systems, when we think of lower-risk MDS, we think of patients who are primarily anemic but don’t have increased blasts in their bone marrow. ... For higher-risk MDS, we want to have that discussion with those patients because their life expectancy is much shorter than patients with lower-risk MDS. We want to see if hematopoietic stem cell transplant would be something that they would be interested in if they don’t have a lot of comorbidities and are relatively healthy.” TS 11:41

“There are a lot of things to consider—[patients’] blood counts, comorbidities, whether they’re frail, and what their goals are. There are some patients where there’s no way they would want to go through transplant. And some patients want to be cured, so it just depends on your patient.” TS 14:22

“I think of hematopoietic allogeneic transplants as a treatment for more of the patients with higher-risk MDS. ... With the Molecular International Prognostic Scoring System (IPSS-M), a patient can have pretty good blood counts and not have increased blasts in the bone marrow. You could send them for a transplant referral upfront without having to give them additional treatment. ... There is a recent publication that said if a patient doesn’t have more than 10% blast, you could refer to transplant as a first option. ... Also, if you had a lower-risk patient who is relatively young and doesn’t have any other treatment options, this would also be a patient that you could refer to transplant to see if we could care for them, and then they wouldn’t have to be getting transfused all the time.” TS 21:12

“I think that we often think low-risk, no treatment needed, but it depends on the person. They often need ongoing supportive care to manage their symptoms even if they’re not getting treatment. And just because we’re not treating them, active observation, bringing them in to see how they’re doing, if they’ve had infections, if their blood counts are changing, that is paying attention to them and doing something. Just because they’re low-risk doesn’t mean they don’t need anything and we can just schedule for a one-year follow-up.” TS 26:30