How to Treat Myelodysplastic Syndromes?

Medical Treatment:

• Transfusion should ideally be with leucodepleted red cells to delay immunisation, as these patients require frequent transfusions.
• Bone marrow transplantation can be curative in selected patients.

For patients with febrile neutropenia within 48 hours of admission:

• 3rd generation cephalosporin, e.g:
• Ceftriaxone, IV, 1 g daily.

PLUS

• Gentamicin, IV, 6 mg/kg daily.

If IV line infection is suspected as the cause at any stage:
ADD:

• Vancomycin, IV, 20 mg/kg/dose 12 hourly.
• Monitor trough levels after the third dose.
• Adjust dose to maintain a trough level of 15-20 micromol/L.

If fever develops after 48 hours of admission:
Choice will depend on local susceptibility patterns. One or more of the following antibiotics/classes must be available:

• Piperacillin/tazobactam, IV, 4.5 g 8 hourly or cefepime, IV, 1 g 12 hourly.

OR
Carbapenem with activity against Pseudomonas, e.g:

• Meropenem, IV, 1 g 8 hourly or Imipenem, IV, 500 mg 6 hourly.

Note:
Ertapenem is not recommended because it is not effective for pseudomonas species which are important pathogens in this setting.
If no response after 5-7 days:
ADD

• Amphotericin B, IV, 1 mg/kg daily in dextrose 5 % over 4 hours.
• Ensure adequate hydration to minimise nephrotoxicity.
• Regular, e.g. 3 times a week, monitoring of potassium, magnesium and renal function is essential.

Duration of therapy:

• If neutrophil count increases to greater than 0.5 x 109/L, continue for 2 days after fever has settled.
• If neutrophil count remains equal to or less than 0.5 x 109/L, continue for 7 days after fever has settled.

When to refer:

• All patients for further investigation and management.