• IPSS low: high intensity therapy inappropriate; for symptomatic anaemia and RA with serum Epo <200U/L, RARS <500U/L consider trial of Epo±G-CSF; otherwise supportive care.

• IPSS intermediate-1: offer allograft to patients <50 years with sibling donor; consider patients aged 50-65 with good performance status and sibling donor for non-ablative conditioning and allograft within clinical trial; offer allograft within clinical trial (ablative or non-ablative conditioning) to patients <40 with MUD donor; Note: pre-transplant cyto-reductive chemotherapy not recommended for IPSS intermediate-1; patients >65 or <65 without donors should be offered supportive care or Epo±G-CSF.

• IPSS intermediate-2/high: consider patients <65 for AML-type cytoreduc-tive chemotherapy; those achieving CR or good PR after induction and consolidation chemotherapy should receive sibling or MUD allograft as detailed for IPSS intermediate-1 patients; those in CR or good PR without any donor but with good performance status and adequate harvest should receive autologous SCT within clinical trial.

0 0

Post a comment