2) Our expert author is Vijaya Raj Bhatt, @VijayaRBhatt1 MBBS, MS, Section Leader, Malignant Hematology, @UNMCHemeOnc @UNMC_IM @NebraskaMed.#onctwitter #FOAMed @MedTweetorials #hemetwitter #Hematologist #Oncologists #MedEd #CancerCare @NCCN @ASCO @ASH_hematology pic.twitter.com/5FddiACSUd— @onc_ce (@onc_ce) April 18, 2023
4) Myelodysplastic syndrome #MDS #MDSsm is a blood #cancer that can be indolent or rapidly fatal like acute #leukemia #AMLsm.— @onc_ce (@onc_ce) April 18, 2023
❓What role can primary care physicians #PCPs play in timely diagnosis, referral, and treatment of patients with low-risk MDS?
5b) … and show variable rates of transformation to acute myeloid leukemia #AML or bone marrow failure. Let's start with a knowledge check. Which of the following is the most common isolated #cytopenia associated with #MDS?— @onc_ce (@onc_ce) April 18, 2023
6a) When should a #PCP suspect #MDS? Here are clues:— @onc_ce (@onc_ce) April 18, 2023
🧩Older age: MDS is uncommon in people < 40-50ys
🧩Prior exposure to chemotx or radiation for other conditions ⬆️risk. Exposure to certain chemicals eg #benzene in 🚗 exhaust, industrial emissions, 🚬) also associated with MDS pic.twitter.com/Bm2RVpPYgx
6c)— @onc_ce (@onc_ce) April 18, 2023
🧩Pts often present w/ normocytic or macrocytic anemia, #bicytopenia or #pancytopenia. Isolated thrombocytopenia or neutropenia are uncommon presentation. Many adults can be asymptomatic at presentation with #cytopenias being detected during routine blood tests.
7a) So how should #PCP approach an adult presenting w/ ⬇️ blood count(s)?— @onc_ce (@onc_ce) April 18, 2023
1⃣Dx of low-risk #MDS req's exclusion of other causes. DDx inc's: nutritional deficiency (vit B12, #folic acid, #copper), exposure to drugs/toxins inc excess 🍸, #marrow suppression from acute illness.
8) When should a patient be referred to #hematology?— @onc_ce (@onc_ce) April 18, 2023
👉A patient who has cytopenia(s) that is unexplained and sustained or severe requires referral.
👉The presence of dysplastic cells or blasts in peripheral smear require referral.
9b) The correct answer is NO. #Dysplastic cells may also be noted in many nonclonal diseases such as infections, autoimmune disorders, nutritional deficiencies, drugs, or toxin exposure.— @onc_ce (@onc_ce) April 18, 2023
See 🔓 https://t.co/DTrUAMDtyk
11a) What are challenges assoc'd w/ dx of low-risk #MDS?— @onc_ce (@onc_ce) April 18, 2023
1⃣ Only #dysplasia or #cytogenetic or molecular abnormalities does NOT establish dx of MDS.
2⃣ Dysplasia alone may be seen in #marrow #biopsy after recovery from non-malignant causes of marrow suppression . . .
11c)— @onc_ce (@onc_ce) April 18, 2023
3⃣Mutations can be present in healthy people (clonal hematopoiesis of indeterminate potential or #CHIP) or those with cytopenias without dysplasia or increased blasts (clonal cytopenia of undetermined significance or #CCUS). pic.twitter.com/nz7icCPCfX
15b)— @onc_ce (@onc_ce) April 18, 2023
🎯 Improve quality of life
🎯 Reduce symptom burden
🎯Prolong life expectancy
🎯Delay the risk of #leukemia
👉Asymptomatic patients with #MDS with mild #cytopenias do not require specific treatment.
16b)— @onc_ce (@onc_ce) April 18, 2023
💉Vaccinations as advised by #ACIP guidelines such as #COVID-19 vaccines, #pneumococcal vaccines, #shingles vaccines, & annual #influenza vaccine can reduce the risk of infections. pic.twitter.com/J5hOFejQ2f
17a) What are some of the tx options for low-risk #MDS?— @onc_ce (@onc_ce) April 18, 2023
Medicines to treat anemia:
👉#ESAs: most effective in a patient with low transfusion need (<2/month) & low erythropoietin level (<500U/L)
👉#Luspatercept: effective in a patient with ringed #sideroblast or #SF3B1 mutation
17c) Other treatment options that may have role in select patients with lower-risk #MDS include immunosuppressive agents such as anti-thymocyte globulin, thrombopoietin mimetics and hypomethylating agent such as azacitidine or decitabine.— @onc_ce (@onc_ce) April 18, 2023