Treatment of Patients with High-Risk MDS | Maher Salamoon, MD | #EHA2025

Hello everyone, I'm Dr. Mahir Salamoun. I'm a hematologist oncologist. I'm working at Alberini University Cancer Center in Damascus, Syria. I make also consultations in Poland, Italy and other countries. I will talk today also, I will speak about another topic which is very important, the high-risk MDS because the myelodysplastic syndrome is divided into several risk criteria groups. So there is a low-risk MDS, moderate, high-risk and high-risk. In the high-risk setting, patients are prone to transform into acute hematogenesis leukemia, AML, which can be a very aggressive disease and the solution will be very bad at that time. So in high-risk patients, so how to define high-risk patients? They are a patient with MDS with a complex carotid with a plus between 12 and 20 percent in the bone marrow and with a morphologic manifestation of refractory anemia with excess blast plus one or two. These patients are treated by guidelines and traditionally either by allogeneic bone marrow transplant in some patients while others are treated by hypometallic agent like the cytobine and azacetidine. In my study, I have demonstrated that treating the patient with, my patient with high dose chemotherapy like cytorabine at the dose of three grams every week for eight consecutive weeks can confer a good response, a good burgeoning of bone marrow. This treatment is combined with upfront treatment with an immunomodulator, lenalidomide at the low dose of 10 milligram per day in continuous anti-disease progression and we can add also azacetidine at the usual standard dose which is 75 milligram per square meter given over consecutive five days of a 28-day schedule. So after the end of induction chemotherapy with cytorabine after eight weeks, we have demonstrated a complete response in 25 percent of patients while after the end of the third month of azacetidine, we have documented a complete response in general of 40 percent rate. The overall survival rate and progression free survival rate after two years of this treatment was 60 percent for our progression free survival and 85 percent were for overall survival rate which is reflecting a good response to treatment because the combination of lenalidomide azacetidine can improve the bone marrow microenvironment and prepare it to another curative therapies.