DR ERBA: A lot of patients end up on ESAs and just stay on them even though they’re transfusion dependent. Usually what I do is, I give at least 3 months, if not 6 months, of an ESA before I claim failure or success. If at the end of 3 to 6 months and they’re not responding, I’ll add in low-dose G-CSF, always making it clear when I make that recommendation that the doctor will have to go to their infusion nurses and make sure they understand that the G is not being given to keep the white count up. It’s being synergistic with the EPO.

I tend to recommend that mostly in patients with refractory anemia with ring sideroblasts, where the response rate seems to be, at least in some studies, a little bit higher.

DR LOVE: Neil?

DR MORGANSTEIN: How do you do it, the details? Like, do you just give 1 dose of G-CSF, like 480 3? Because that’s always something that comes up if you give pegfilgrastim.

DR ERBA: I don’t give pegfilgrastim. I think that could cause a lot of discomfort in these patients who may still be able to make neutrophils. Because it’s mostly the anemia you’re concerned about.

So I usually give 0.2 of a cc of G-CSF.

Important clinical issues in the management of MDS

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