b'u From Page 21are found to have leukopenia while on TPs, a hematologi-calconsultshouldbecon-sideredforapossiblebone marrowbiopsyevaluation especially among the elderly population subgroup.Veteranscurrentlyusing thiopurineswhohada cumulative exposure of less than two years to the drugs had triple the risk of AML/MDSonanadjustedbasis comparedtothosenever exposed.Thosewhowere currentlyusingthiopurinesSource: National Cancer Institute; https://prevention.cancer.gov/news-and-events/blog/study-seeks-unraveland had more than two years of exposure had an adjusted risk 2.32 times that ofinfusions. Azacitidine and decitabine can be used for individuals never exposed to the drugs. Past use ofall types of MDS; lenalidomide is indicated only for thiopurines was not associated with any increasedthe 5q-syndrome type.risk of AML/MDS.In the last two years, luspatercept, an infused ery-While older age predictably increased the risk ofthroid maturation agent, gained approval for use in AML/MDS, there was no significant multiplicativepatients with anemia who have failed erythropoie-interaction between the age and the TP exposure sta- sis-stimulating agent and need two or more trans-tus, the team said. However, it should be noted thatfusions in a two-month period. It is indicated for because elderly have an increased absolute risk ofvery low-risk to intermediate-risk MDS with ring developing AML/MDS, if they are prescribed a TP,sideroblasts.the absolute risk increase is higher than that in theAlso in 2020, a tablet that combines decitabine and younger population. cedazuridine received the FDA green light, making The team added a bit of good news from the study:it the first oral treatment for MDS. It is indicated for theelevatedriskofAML/MDSassociatedwitha broad range of MDS patients including previously exposure to thiopurines reverted to baseline withintreated and treatment nave individuals with de novo six months of discontinuation.or secondary MDS with refractory anemia, refrac-tory anemia with ringed sideroblasts or refractory Treatment Options in MDS anemia with excess blasts. It is approved for patients For those who develop MDS, recent developmentsin the intermediate-1, intermediate-2 and high-risk provide more options for treatment. Many patientsInternational Prognostic Scoring System groups.are eligible for watchful waiting as MDS can takeOtheragentsarealsoonthehorizonforMDS an indolent course. Others require more-aggressiveincluding venetoclax, which is already used in AML. treatment and frequent transfusions. While the onlyMagrolimab,amacrophageimmunecheckpoint curative therapy is a blood marrow transplant, dis- inhibitor,thatappearspromisinginpatientswith ease-modifying therapies can slow progression andTP53 mutations.extend survival for some patients without the toxic- 1Khan N, Patel D, Trivedi C, Kavani H, Pernes T, Medvedeva E, Lewis ity of chemotherapy.J, Xie D, Yang YX. Incidence of Acute Myeloid Leukemia and My-No new drugs for MDS gained U.S. Food and Drugelodysplastic Syndrome in Patients With Inflammatory Bowel Disease Agency approval between the 2006 okay of lenalido- and the Impact of Thiopurines on Their Risk. Am J Gastroenterol. 2021 Apr;116(4):741-747. doi: 10.14309/ajg.0000000000001058. mide and 2020, leaving patients and physicians toPMID: 33982944.choosebetweenthreeazanucleotidesdeliveredas 27'