Guidelines for the Management of Haematological Malignancies

mainstay of treatment, but selected groups may benefit from chemotherapy and other specific
treatment.(Bowen, Culligan et al. 2003)
Anaemia
• RBC transfusion should be considered in any patient with symptomatic anaemia.
• Iron chelation with s/c desferrioxamine should be considered principally in stable transfusiondependent
patients with low/INT-1 IPSS score (predicted survival > 4 yrs)(especially pure
sideroblastic anaemia [WHO RARS], pure refractory anaemia [WHO RA] and 5q- syndrome).
Initiate iron chelation at serum ferritin >1000 mcg/l, with annual eye and ear assessment.
There is no evidence for benefit from IV desferal given at the same time as blood
transfusion.Desferrioxamine remains chelator of choice if tolerant and effective. Alternatives
are Deferiprone(This is not licensed for these indications and it need a weekly full blood count
and should be initiated only if the baseline neutrophils > 1.5 x 109/l), Deferasirox and
Combination of Deferiprone daily plus Desferrioxamine 3 x /week
Erythropoietin (EPO) +/- G-CSF can reduce transfusion requirements in selected patients. This will
become increasingly important as blood supplies fall. But this should be restricted to patients with
Serum EPO < 500 IU/l and Low transfusion requirement (≤ 2 units / month)
A randomised phase 3 controlled trial is likely to be open in late 2007
Immunosuppression with ALG or cyclosporin can be beneficial in hypoplastic MDS, but also in normoor
hyper-cellular low-risk groups (IPSS INT-1 or less). ALG should only be used in patients