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Sideroblastic Anaemia (MDS-RS) — RACP Adult Medicine MCQ

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HardHaematologySideroblastic Anaemia (MDS-RS)RACP Adult Medicine

A transplant-ineligible patient with higher-risk MDS starts standard azacitidine. Before cycle 4, neutrophils and platelets are lower than baseline but marrow blasts have fallen and there is no uncontrolled infection or bleeding. What is the best principle?

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Correct answer: A — Use marrow response and count-recovery kinetics before changing dose intensity

Explanation lettering: B = shown as A · D = shown as B · E = shown as D · A = shown as E

B is correct because early treatment-related cytopenias are common; dose timing and modification depend on baseline counts, nadir, marrow cellularity and recovery, while unnecessary early attenuation may compromise efficacy. C ignores falling blasts and treatment kinetics. D uses one delayed recovery point without global risk assessment. E has no routine prophylactic role. A confuses higher-risk disease with a selected lower-risk anaemia indication. The eviQ protocol specifies count- and recovery-based decisions with haematologist individualisation.

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