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Myelodysplastic Syndrome — RACP Adult Medicine MCQ

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HardHaematologyMyelodysplastic SyndromeRACP Adult Medicine

A patient with higher-risk myelodysplastic syndrome begins azacitidine. After two cycles, counts have not improved, but toxicity is manageable and there is no progression. What is the best interpretation?

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Correct answer: D — Continue scheduled cycles and reassess response after four to six cycles

D is correct because azacitidine response may take multiple cycles—commonly assessed over roughly four to six cycles when clinically safe—and ongoing therapy benefits responders. E changes hypomethylating therapy prematurely. A ignores marrow recovery, toxicity and protocol-based dose decisions. B abandons disease-modifying treatment before a fair response assessment. C exposes a stable patient to disproportionate treatment before the planned trial is complete. Progression, infection, severe toxicity and transplant strategy can change the plan earlier.

Reference: eviQ, Myelodysplastic syndrome azacitidine: https://www.eviq.org.au/haematology/leukaemias/myelodysplastic-disorders/1173-myelodysplastic-syndrome-azacitidine