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Accreditation/Credit Designation

Physicians' Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Physicians' Education Resource®, LLC, designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Acknowledgment of Commercial Support

This activity is supported by educational grants from Astex Pharmaceuticals, Inc, and Celgene Corporation.

Medical Crossfire®: Changing the Paradigm in Myelodysplastic Syndromes: How Do Patient Factors Impact Treatment Decisions?


Release Date: December 31, 2018
Expiration Date: December 31, 2019
Media: Internet - based

Activity Overview

This activity, Medical Crossfire®: Changing the Paradigm in Myelodysplastic Syndromes: How Do Patient Factors Impact Treatment Decisions? is designed to update clinicians on the latest strategies to optimize outcomes for patients with myelodysplastic syndromes (MDS). As clinicians who treat patients with MDS, you require a solid understanding of the diagnostic criteria used to accurately identify patients with MDS, and to rule out other potential hematologic disorders. In addition, you need to be aware of revisions to the revised International Prognostic Scoring System (IPSS-R) for MDS, how these changes impact risk categorization, and implications for treatment selection. It is vital to understand when to observe and when to treat a patient newly diagnosed with MDS, and how to select between the available therapeutic options. For patients with relapsed or refractory MDS, it is essential to be aware of current options and how to individualize treatment plans. Finally, you want to be up-to-date on emerging agents and clinical trial options to expand opportunities for your patients with MDS.

To help you meet these goals, we have developed an educational activity that features case-based interactive discussions with our panel of experts, who will share their perspectives on diagnosing MDS and assessing risk, as well as state-of-the-art treatment strategies and the latest clinical trial data so that you can appropriately optimize the care and management of your patients.

Benefits of Participating

  • Understand how to diagnose and categorize MDS
  • Learn how to tailor available treatment options for patients with MDS based on risk classification and patient comorbidities
  • Hear experts discuss how they apply guidelines and data to real-world patient scenarios
  • Explore options for clinical trials investigating novel agents and new strategies for MDS

Acknowledgement of Commercial Support

This activity is supported by educational grants from Astex Pharmaceuticals, Inc, and Celgene Corporation.

Instructions for This Activity and Receiving Credit

  • You will need to log in to participate in the activity.
  • Each presentation may contain an interactive question(s). You may move forward through the presentation; however, you may not go back to change answers or review audio files/content until you finish the presentation.
  • At the end of the activity, educational content/audio files will be available for your reference.
  • In order to receive a CME certificate, you must complete the activity.
  • Complete the Posttest and pass with a score of 70% or higher, complete the Evaluation, and then click on “Request for Credit.” You may immediately download a CME certificate upon completion of these steps.


Target Audience

This educational activity is directed toward hematologists, oncologists, fellows, nurse practitioners, physician assistants, nurses, and other healthcare professionals interested in the treatment of MDS.

Learning Objectives

Upon successful completion of this activity, you should be better prepared to:

  • Explain the current categorization of MDS disease and how risk stratification informs clinical decision-making
  • Describe current treatment strategies for MDS and guidelines, and how risk for progression to acute myeloid leukemia (AML) impacts management
  • Determine how individual patient characteristics impact prognosis, including response to therapies, survival, or progression to AML
  • Place recent evidence concerning novel MDS treatment strategies into the context of evolving treatment paradigms in the field

Faculty, Staff, and Planners' Disclosures

Chair

David P. Steensma, MD
Associate Professor of Medicine
Harvard Medical School
Institute Physician
Adult Leukemia Program
Dana-Farber Cancer Institute
Boston, MA

Disclosures: Grant/Research Support: Celgene, H3 Biosciences; Consultant: Novartis, Janssen, Otsuka, Takeda, Sensei; Stock/Shareholder: Array, Galectin

Faculty

Jamie Koprivnikar, MD
Medical Oncologist
John Theurer Cancer Center
Hackensack, NJ
 
 

Disclosures: Consultant: Partner Therapeutics, Alexion; Speakers Bureau: Alexion, Amgen

Aziz Nazha, MD
Assistant Professor
Lerner College of Medicine
Associate Staff
Taussig Cancer Institute
Cleveland Clinic
Cleveland, OH

Disclosures: Consultant: Karyopharm, Tolero; Data Monitoring Committee: MEI

Amer Zeidan, MDDS, MHS
Assistant Professor of Medicine
Yale University School of Medicine
Yale Cancer Center
New Haven, CT
 

Disclosures: Grant/Research Support: Celgene, Acceleron, Pfizer; Consultant: Celgene, Pfizer, Acceleron, Astellas, Daiichi Sankyo, Otsuka, AbbVie, Ariad, Novartis, Takeda, Agios; Speakers Bureau: Takeda

The staff of PER® have no relevant financial relationships with commercial interests to disclose.

Disclosure Policy and Resolution of Conflicts of Interest (COI)

As a sponsor accredited by the ACCME, it is the policy of PER® to ensure fair balance, independence, objectivity, and scientific rigor in all of its CME activities. In compliance with ACCME guidelines, PER® requires everyone who is in a position to control the content of a CME activity to disclose all relevant financial relationships with commercial interests. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that creates a COI.

Additionally, PER® is required by ACCME to resolve all COI. PER® has identified and resolved all COI prior to the start of this activity by using a multistep process.

Off-Label Disclosure and Disclaimer

This CME activity may or may not discuss investigational, unapproved, or off-label use of drugs. Participants are advised to consult prescribing information for any products discussed. The information provided in this CME activity is for continuing medical and nursing education purposes only, and is not meant to substitute for the independent clinical judgment of a physician relative to diagnostic, treatment, or management options for a specific patient’s medical condition. The opinions expressed in the content are solely those of the individual faculty members and do not reflect those of PER®.

PER Pulse™ Recaps

1 of 3
Medical Crossfire®: Changing the Paradigm in Myelodysplastic Syndromes: How Do Patient Factors Impact Treatment Decisions?

Diagnosis and Risk Assessment for Patients With Myelodysplastic Syndromes

Medical Crossfire®: Changing the Paradigm in Myelodysplastic Syndromes: How Do Patient Factors Impact Treatment Decisions? is designed to update you on the latest strategies to optimize outcomes for patients with myelodysplastic syndromes (MDS). This activity will increase your ability to accurately identify patients with MDS, and to rule out other potential hematologic disorders. In addition, you will review risk assessment using the revised International Prognostic Scoring System (IPSS-R) for MDS, and how to integrate results to individualize treatment selection. Finally, you will learn about emerging treatment strategies and clinical trial options to expand opportunities for your patients with MDS. This activity features case-based interactive discussions with a panel of internationally recognized experts, including David P. Steensma, MD; Jamie Koprivnikar, MD; Aziz Nazha, MD; and Amer Zeidan, MBBS, MHS. The panelists share their perspectives on diagnosing MDS and assessing risk, as well as state-of-the-art treatment strategies, recent trial data, and challenging clinical scenarios.

This first of 3 PER® Pulse™ Recaps focuses on the diagnosis of patients who are suspected of having MDS, and prognostic criteria used for assessing risk. Highlights include:

  • Other possible disorders that may cause symptoms or cytopenias that mimic MDS include nutritional deficiencies, clonal hematopoiesis of indeterminate potential (CHIP), and viral infection. Concurrent medications for other medical problems can also cause low blood counts, so a careful review of the patient’s medical history can be informative when bloodwork and bone marrow biopsy are not absolutely diagnostic for MDS.
  • Guidelines for a decisive diagnosis of MDS by an International Consensus Working Group require that a patient meet at least 1 of the following criteria: dysplasia ≥10% of ≥1 cell lineages in the bone marrow, or a blast percentage between 5% and 19%, or a specific MDS-related associated karyotype [eg, del(5q), del (20q), +8, or -7/del(7q)]. Mutations detected by next-generation sequencing (NGS) are not sufficient for a definitive diagnosis.
  • Patients with CHIP, also known as age-related clonal hematopoiesis, have a natural history similar to low-risk MDS, and are at higher risk of progressing to MDS or AML. In addition, they are at greater risk of developing cardiovascular disease.
  • It is important to categorize patients with MDS by risk correctly, because expert guidelines and treatment algorithms are based on risk stratification. The IPSS scoring system has traditionally been the most common prognostic tool used in the clinic.
  • The original IPSS calculator included percentage of blasts, number of cytopenias, and karyotype. In 2012, the International Working Group for the Prognosis of MDS developed a revised version of the prognostic scoring system that is more comprehensive and has better predictive ability. The IPSS-R incorporates the degree of individual cytopenias (as well as number) and has been expanded from 4 to 5 risk categories (very low, low, intermediate, high, very high).
    • For patients categorized as intermediate risk, those with scores ≤3.5 tend to be at lower risk, while those whose scores are ≥4.0 tend to be at higher risk.
    • Age is also an important prognostic variable for survival, but is not associated with risk of transformation to AML.
    • It is important to recognize that survival estimates based on risk category were developed from untreated patient cohorts; treatment may modify survival times, and patients should be counseled accordingly.

2 of 3
Medical Crossfire®: Changing the Paradigm in Myelodysplastic Syndromes: How Do Patient Factors Impact Treatment Decisions?

Using Risk Stratification to Guide Treatment Selection for Patients with Myelodysplastic Syndromes

Medical Crossfire®: Changing the Paradigm in Myelodysplastic Syndromes: How Do Patient Factors Impact Treatment Decisions? is designed to update you on the latest strategies to optimize outcomes for patients with myelodysplastic syndromes (MDS). This activity will increase your ability to accurately identify patients with MDS, and to rule out other potential hematologic disorders. In addition, you will review risk assessment using the revised International Prognostic Scoring System (IPSS-R) for MDS, and how to integrate results to individualize treatment selection. Finally, you will learn about emerging treatment strategies and clinical trial options to expand opportunities for your patients with MDS. This activity features case-based interactive discussions with a panel of internationally recognized experts, including David P. Steensma, MD; Jamie Koprivnikar, MD; Aziz Nazha, MD; and Amer Zeidan, MBBS, MHS. The panelists share their perspectives on diagnosing MDS and assessing risk, as well as state-of-the-art treatment strategies, recent trial data, and challenging clinical scenarios.

This second of 3 PER Pulse™ Recaps focuses on tailoring first-line treatment for patients with MDS based on risk category and transplant eligibility, as well as therapeutic options for patients who relapse or experience first-line treatment failure. Highlights include:

  • Treatment options for MDS can vary from observation for lower-risk patients to immediate transplantation for those at highest risk.
    • The main goal for patients with lower-risk disease is maintenance of quality of life and reducing the need for transfusions. There are currently no therapies that have been proven to extend survival in lower-risk MDS.
    • Median survival for untreated high-risk MDS is <1 year, so more aggressive treatments are appropriate for these patients.
      • Allogeneic bone marrow transplantation is the only curative treatment for MDS, but is associated with increased risks of morbidity and mortality.
      • Hypomethylating agents (HMAs; azacitidine, decitabine) are approved by the US Food and Drug Administration for high-risk MDS, but they are not curative. It is important to recognize that it can take up to 6 cycles to see a response with these agents, and, due to the side effects, cytopenias may initially worsen before improving.
        • For patients with high-risk MDS who are not candidates for transplantation, HMAs are the current standard of care.
        • For patients who are eligible for transplantation, HMAs may also be useful to reduce disease burden in those with elevated blast counts. Lower blast counts (<5%) have been associated with better outcomes after transplant.
        • A meta-analysis of studies of azacitidine in MDS found that complete remissions were seen in 10% to 17% of patients, and hematologic improvement was observed in an additional 23% to 36% of patients, with a median number of 3 cycles to first response.
        • The presence of TET2 mutations has been associated with increased response to HMAs in patients with MDS. In contrast, ASXL1 mutations have been associated with decreased sensitivity.
    • For patients with MDS that does not respond to or progresses on an HMA, transplantation remains an option for those who are eligible. Other possibilities include more intensive induction regimens, or off-label use of agents that have demonstrated efficacy in the setting of AML, such as venetoclax. Clinical trials are always an excellent option.

3 of 3
Medical Crossfire®: Changing the Paradigm in Myelodysplastic Syndromes: How Do Patient Factors Impact Treatment Decisions?

Emerging Treatment Approaches for Myelodysplastic Syndromes

Medical Crossfire®: Changing the Paradigm in Myelodysplastic Syndromes: How Do Patient Factors Impact Treatment Decisions? is designed to update you on the latest strategies to optimize outcomes for patients with myelodysplastic syndromes (MDS). This activity will increase your ability to accurately identify patients with MDS, and to rule out other potential hematologic disorders. In addition, you will review risk assessment using the revised International Prognostic Scoring System (IPSS-R) for MDS, and how to integrate results to individualize treatment selection. Finally, you will learn about emerging treatment strategies and clinical trial options to expand opportunities for your patients with MDS. This activity features case-based interactive discussions with a panel of internationally recognized experts, including David P. Steensma, MD; Jamie Koprivnikar, MD; Aziz Nazha, MD; and Amer Zeidan, MBBS, MHS. The panelists share their perspectives on diagnosing MDS and assessing risk, as well as state-of-the-art treatment strategies, recent trial data, and challenging clinical scenarios.

This third of 3 PER Pulse™ Recaps focuses on novel agents and therapeutic strategies currently being investigated for the treatment of MDS. Highlights include:

  • New approaches being investigated for low-risk MDS include novel erythroid maturation agents, lenalidomide for non-del(5q) disease, oral formulations of HMAs, and telomerase inhibitors. For higher-risk disease, strategies being explored include BCL-2 inhibitors (venetoclax), IDH inhibitors (ivosidenib, enasidenib), p53-targeted agents (APR-246), immune checkpoint inhibitors, and cytotoxic agents (CPX-351) that have demonstrated efficacy in acute myeloid leukemia.
  • The recently reported phase III MEDALIST trial compared luspatercept, an erythroid maturation agent, versus placebo in patients with transfusion-dependent, low- to intermediate-risk MDS with ring sideroblasts with an SF3B1 mutation. The rate of transfusion independence achieved with luspatercept was 38%.
  • Lenalidomide is approved by the FDA for use in patients with anemia associated with low- or intermediate-risk MDS with del(5q). In a phase III study of this patient population, 37% of patients achieved transfusion independence at a dose of 5 mg and 57% at a dose of 10 mg. Lenalidomide has also been evaluated in patients with low-/intermediate-risk non-del(5q) MDS in phase II and phase III trials, with approximately one-fourth of patients achieving transfusion independence in these studies.

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