An update on the treatment of myelodysplastic syndromes

Management of older and frail patients with multiple myeloma in the Portuguese routine clinical practice: Deliberations and recommendations from an expert panel of hematologists

The management of older patients with Multiple Myeloma (MM) is particularly challenging due to the highly heterogeneous nature of this population, both in terms of physical and cognitive functioning. Older patients may be divided into fit, intermediate and frail, with variable abilities to tolerate treatments. A careful and correct assessment of the frailty status is thus paramount for the success of therapy and for improving outcomes. With the aging of the European population, the number of older patients with MM is rapidly growing. We hereby present the deliberations and recommendations from an expert panel of Portuguese hematologists conducted to discuss the management of this population, including how to stratify and treat older patients with MM according to their frailty status. The use of frailty tools is critical for the development of individualized risk-adapted treatment strategies and to minimize the risk of under or overtreatment. Aggressive therapies should be used in fitter patients to improve survival outcomes, while frail patients should generally be treated with less toxic approaches to control symptoms while minimizing toxicity. In intermediate-fit patients, low-dose triplets are recommended to achieve a balance between improving survival and maintaining quality of life. The management of older patients with MM should be performed by a multidisciplinary team in view of their advanced age and high prevalence of comorbidities. The inclusion of older and frail patients in future clinical trials investigating treatment regimens for MM is crucial to evaluate treatment feasibility and to improve clinical decision making in this population.

Subcutaneous administration of bortezomib: strategies to reduce injection site reactions

Bortezomib (Velcade) is approved by the FDA for IV or SC injection in select patients with multiple myeloma or mantle cell lymphoma. The SC route functions as an alternative to IV administration for patients with poor IV access. Learn about effective strategies used to reduce injection site reactions that can occur with SC delivery.

Myelodysplastic syndromes: the challenge of developing clinical guidelines and supportive care strategies for a rare disease

Myelodysplastic syndromes (MDS) represent a group of clonal myeloid malignancies with variability in clinical presentation and disease trajectory, as well as prognosis and treatment recommendations (Kurtin & Demakos, 2010). MDS is considered to be a rare disease that is most common in adults older than age 70. The disease is characterized by ineffective hematopoiesis, progressive bone marrow failure, and a variable risk of leukemic transformation thought to result from complex interactions between the malignant clone and the bone marrow microenvironment (Kurtin, 2011). This supplement is intended to provide the oncology clinician with an overview of MDS and provide tools for the clinical management and support of patients with MDS.

Update on the science of myelodysplastic syndromes

Scientific research is only just beginning to shed light on the pathobiology underlying the various subtypes of myelodysplastic syndromes (MDS), a heterogeneous group of clonal stem cell disorders characterized by cytopenias that can progress to acute myeloid leukemia. Increased understanding of the disease and prognostic implications of specific clinical features has aided in the development of prescribing guidelines and new treatments for MDS. Because oncology nurses have frequent interactions with patients during diagnostic and therapeutic evaluations, an understanding of the science behind disease classification, prognostic scoring, and the goals of treatment for low- and high-risk disease is important to answer questions regarding diagnostic results, treatment outcomes, and adverse event monitoring.