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Is Vidaza Or Revlimid Best For MDS?
Question: Hello, yes I have a question. In the treatment of MDS which is best alternative to use, Vidaza or Revlimid for people over 65? Has their been recent studies that conclude one or the other drug has a better success rate, or is it better to go the stem cell transplant route if one is able too?
Thanks. XXXX, YYYY@YYYY
Thanks. XXXX, YYYY@YYYY
Brief Answer:
They have different roles
Detailed Answer:
Hi
Thanks for your query.
MDS is a mixed bag of disorders. It has various sub-entities which behave differently and their treatment is also different.
The risk classification and cytogenetics play an important part. The international risk scoring system (IPSS-R) based upon cytogenetics, bone marrow blasts and blood counts is pivotal in deciding treatment. (Link http://www.mds-foundation.org/ipss-r-calculator/)
Patients with a very low (≤1.5 points) or low (>1.5 to 3 points) IPSS-R score are primarily treated with supportive care or low intensity therapies such as azacitidine or decitabine. Patients with a high (>4.5 to 6 points) or very high (>6 points) IPSS-R score with a good performance status are primarily treated with combination chemotherapy or allogeneic hematopoietic cell transplantation. Either of these are applicable for intermediate scores.
Lenalidomide (Revlimid) is specifically for those with 5q deletion. It can't be compared head to head with azacitidine (Vidaza) as it works only in this group of patients.
Transplant is used sparingly over 65 but definitely can be considered if the patient is fit without too many comorbid illnesses.
Hope this helps.
Regards
They have different roles
Detailed Answer:
Hi
Thanks for your query.
MDS is a mixed bag of disorders. It has various sub-entities which behave differently and their treatment is also different.
The risk classification and cytogenetics play an important part. The international risk scoring system (IPSS-R) based upon cytogenetics, bone marrow blasts and blood counts is pivotal in deciding treatment. (Link http://www.mds-foundation.org/ipss-r-calculator/)
Patients with a very low (≤1.5 points) or low (>1.5 to 3 points) IPSS-R score are primarily treated with supportive care or low intensity therapies such as azacitidine or decitabine. Patients with a high (>4.5 to 6 points) or very high (>6 points) IPSS-R score with a good performance status are primarily treated with combination chemotherapy or allogeneic hematopoietic cell transplantation. Either of these are applicable for intermediate scores.
Lenalidomide (Revlimid) is specifically for those with 5q deletion. It can't be compared head to head with azacitidine (Vidaza) as it works only in this group of patients.
Transplant is used sparingly over 65 but definitely can be considered if the patient is fit without too many comorbid illnesses.
Hope this helps.
Regards
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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