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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.