Optimizing the Continuum of Care for MDS

A Series of Four Programs:

Anemia Differentiation in the Elderly: When to Refer

Anemia is often considered a normal consequence of the aging process, and the underlying cause is often not evaluated. Unidentified or untreated anemia may have far reaching consequences and may be the manifestation of an underlying bone marrow failure condition, such as myelodysplastic syndromes (MDS). Furthermore, there is recent data to suggest that the true incidence of MDS in the population may be much higher than previously thought. Primary care practitioners (PCPs) are often the gatekeepers in healthcare and consequently need to be able to differentiate among the different etiologic causes of geriatric anemia in order to provide optimal management of these patients, including who and when to refer.

Upon completion of this educational activity, practitioners should be able to identify the most useful tests to differentiate among causes of anemia in elderly patients and recognize characteristic symptoms of MDS.

Faculty:

Mikkael A. Sekeres, MD, MS
Associate Professor of Medicine
Director, Leukemia Program
Cleveland Clinic Taussig Cancer Center
Cleveland, OH

David P. Steensma, MD, FACP
Associate Professor of Medicine
Harvard Medical School
Leukemia Group
Dana-Farber Cancer Institute
Boston, MA

Brian Koffman, MDCM, FCFP, DABFP, MS Ed
Clinical Professor of Family Medicine
USC Keck School of Medicine
Private Practice
St. Jude Heritage Medical Group
Diamond Bar, CA

Target Audience:

This activity is designed to meet the educational needs of primary care physicians, nurse practitioners, physician assistants, and other health care professionals involved in the management of geriatric patients with anemia.

Educational Objectives:

This activity was designed to address the following IOM competencies: provide patient-centered care; work in interdisciplinary teams; employ evidence-based practice.
At the conclusion of this activity, participants should be able to:

1. Differentiate among the various etiological causes of anemia seen in geriatric patients
2. Describe the characteristics of anemia caused by occult blood loss vs a failure of hematopoiesis
3. Indicate strategies to manage anemic patients, including appropriate referral to specialists

Making a Definitive Diagnosis of MDS

Recognition and definitive diagnosis of myelodysplastic syndromes (MDS) represents a significant challenge, as patients often present with diffuse manifestations of an underlying cytopenia, such as anemia, and MDS must be differentiated from numerous overlap conditions. Definitive diagnosis of MDS requires morphologic and cytogenetic evaluation of a bone marrow specimen; however, these evaluations are currently performed on only about one-half of patients. MDS diagnosis represents a particular challenge in community practice, where clinicians see few cases of MDS compared to other tumor types. This activity will define current World Health Organization (WHO) criteria for making a definitive diagnosis of MDS and current staging systems used to assess prognostic risk for leukemic progression or mortality. The importance of bone marrow specimen quality and interdisciplinary collaboration between community-based pathologists and hematologists/oncologists in the process of making an accurate diagnosis will be highlighted.

Upon completion of this educational activity, practitioners should be able to make a definitive diagnosis of MDS according to WHO 2008 criteria and evaluate the prognostic accuracy of staging systems for MDS.

Faculty

Mikkael A. Sekeres, MD, MS
Associate Professor of Medicine
Director, Leukemia Program
Cleveland Clinic Taussig Cancer Center
Cleveland, OH

David P. Steensma, MD, FACP
Associate Professor of Medicine
Harvard Medical School
Leukemia Group
Dana-Farber Cancer Institute
Boston, MA

David B. Wilson, MD, FACP
Director of Hematopathology
AmeriPath Indiana
Indianapolis, IN

Target Audience:

This activity is designed to meet the educational needs of pathologists, hematologist/oncologists, nurse practitioners, physician assistants, and other health care professionals involved in the management of patients with hematologic malignancies.

Educational Objectives:

This activity was designed to address the following IOM competencies: provide patient-centered care; work in interdisciplinary teams; employ evidence-based practice.

At the conclusion of this activity, participants should be able to:

1. Review the morphologic/cytogenetic classification of MDS and the importance of bone marrow biopsy
2. Indicate the key components of the WHO 2008 classification of MDS and the minimal criteria required to make a definitive diagnosis of MDS 
3. Accurately diagnose, classify, and stage/risk-stratify patients with myelodysplastic syndrome (MDS)

Management of Patients with IPSS Low/Int-1 Risk Myelodysplastic Syndromes

While several active therapies are now available to treat myelodysplastic syndromes (MDS), choosing among these agents using current treatment algorithms can be a challenge for the community-based practitioner, who may not be familiar with the available therapies and may see few cases of MDS compared to other tumor types. This activity will provide practical information on the management of patients with Low-/Int-1-risk MDS, according to the International Prognostic Scoring System (IPSS), using active therapies and/or supportive care. Criteria used in addition to IPSS for therapy selection (type of cytopenia, cytogenetics, serum epo levels, and predictors of response to immunosuppressive therapy) will be defined.

Upon completion of this educational activity, practitioners should be able to select active therapies for IPSS Low-/Int-1-risk MDS based on disease and patient characteristics. In addition, practitioners should know what to expect from treatment with newer therapies, including expected response and the approach to manage toxicities.

Faculty:

Mikkael A. Sekeres, MD, MS
Associate Professor of Medicine
Director, Leukemia Program
Cleveland Clinic Taussig Cancer Center
Cleveland, OH

David P. Steensma, MD, FACP
Associate Professor of Medicine
Harvard Medical School
Leukemia Group
Dana-Farber Cancer Institute
Boston, MA

Steven L. Allen, MD, FACP
Professor of Medicine
Hofstra North Shore - LIJ School of Medicine
Associate Chief, Division of Hematology
Monter Cancer Center
North Shore - LIJ Health System
Lake Success, NY

Target Audience:

This activity is designed to meet the educational needs of hematologist/oncologists, nurse practitioners, physician assistants, and other health care professionals involved in the management of patients with myelodysplastic syndromes.

This activity was designed to address the following IOM competencies: provide patient-centered care; work in interdisciplinary teams; employ evidence-based practice

Educational Objectives:
At the conclusion of this activity, participants should be able to:

• Select appropriate therapies for IPSS Low/Int-1-risk MDS based on patient age and type of cytopenia, as well as biochemical, immunophenotypic, and cytogenetic criteria
• Define the role of iron chelation therapy in chronically transfused patients with IPSS Low/Int-1-risk MDS
• Indicate the expected outcomes and approach to managing toxicities of the commonly used therapies for IPSS Low/Int-1-risk MDS

Management of Patients with IPSS Int-2 High Risk Myelodysplastic Syndromes

While several active therapies are now available to treat myelodysplastic syndromes (MDS), choosing among these agents using current treatment algorithms can be a challenge for the community-based practitioner, who may not be familiar with the available therapies and may see few cases of MDS compared to other tumor types. This activity will provide practical information on the management of patients with Int-2/High-risk MDS, according to the International Prognostic Scoring System (IPSS), including current best practices and optimal use of intensive therapy, hypomethylating agents, and/or supportive care. Patient management in the context of currently available clinical trials will also be discussed.

Upon completion of this educational activity, practitioners should be able to select active therapies for IPSS Int-2/High-risk MDS based on disease and patient characteristics. In addition, practitioners should know what to expect from treatment with newer therapies, including expected response and approaches to manage toxicities.

Faculty:

Mikkael A. Sekeres, MD, MS
Associate Professor of Medicine
Director, Leukemia Program
Cleveland Clinic Taussig Cancer Center
Cleveland, OH

David P. Steensma, MD, FACP
Associate Professor of Medicine
Harvard Medical School
Leukemia Group
Dana-Farber Cancer Institute
Boston, MA

Sanjay Sharma, MD
Oncology Medical Director
Virginia K. Crosson Cancer Center
St. Jude Heritage Medical Group
Fullerton, CA

Target Audience:

This activity is designed to meet the educational needs of hematologist/oncologists, nurse practitioners, physician assistants, and other health care professionals involved in the management of patients with myelodysplastic syndromes.

Educational Objectives:

This activity was designed to address the following IOM competencies: provide patient-centered care; work in interdisciplinary teams; employ evidence-based practice

At the conclusion of this activity, participants should be able to:

1. Select appropriate intensive or non-intensive therapies for patients with IPSS Int-2/High-risk MDS based on patient age, donor availability, and disease characteristics
2. Define the appropriate use of hypomethylating agents in the management of patients with IPSS Int-2/High-risk MDS
3. Indicate the expected outcomes and approach to managing toxicities of the commonly used therapies for IPSS Int-2/High-risk MDS