MYELODYSPLASTIC SYNDROME ARSENIC TRIOXIDE Arsenic trioxide 0.3 mg/kg/day IV* Days 1 – 5, Week 1 only Followed by Arsenic trioxide 0.25 mg/kg/day IV* Twice weekly, Week 2 onwards *Administer over 1 – 2 hours. Continue arsenic trioxide until disease progression, major response or complete remission. Reference: Vey N, et al. J Clin Oncol 2006;24:2465 - 71. ARSENIC TRIOXIDE Arsenic trioxide 0.25 mg/kg/day IV* Days 1 – 5 – Week 1 and 2 *Administer over 1 – 2 hours. Repeat cycle every 28 days. Reference: Schilller GJ, et al. J Clin Oncol 2006;24:2456 - 64. AZACITIDINE Azacitidine 75 mg/m2/day SQ Days 1 – 7 Repeat cycle every 28 days to a maximum of 7 cycles if CR. Patients with PR/improvement continue therapy until CR or relapse. DOSE MODIFICATION: If a beneficial effect is not evident by the start of the 3rd cycle (Day 57), the dose may be increased by 33%. NOTE: Depending on the dose of azacitidine the volume of the SQ injection may be large, i.e., up to 4 mL. Check patient preferences for multiple injections. Reference: Silverman LR, et al. J Clin Oncol 2002;20:2429 – 40. DECITABINE Decitabine 15 mg/m2 Q8H IV* Days 1 – 3 *Administer over 3 hours. Repeat cycle every 6 weeks. Discontinue decitabine therapy if a partial response is not achieved after 6 cycles or if a complete remission is not attained after 8 cycles of therapy. Continue treatment for 2 cycles after achieving a complete remission. Reference: Kantarjian H, et al. Cancer 2006;106:1794 – 803. Last Updated on September 24, 2007 DECITABINE Decitabine 20 mg/m2/day IV* Days 1 – 5 *Administer over 1 hour. Repeat cycle every 4 weeks. DOSE MODIFICATION: Dose reductions were permitted for Grade 3-4 non-myelosuppressive toxicities or for prolonged myelosuppression defined as a hypocellular marrow (≤5% cellularity). References: Kantarjian H, et al. Blood 2007;109:52 – 7; Kantarjian HM, et al. Cancer 2007;109:265 – 73. IMATINIB (GLEEVEC®) Imatinib 400 mg/day PO Daily NOTE: Imatinib is indicated for the treatment of adult patients with MDS/MPD associated with platelet-derived growth factor receptor (PDGFR) gene rearrangements. Reference: Novartis Pharmaceuticals Package Insert, October 2006. LENALIDOMIDE (REVLIMID®) Lenalidomide 10 mg/day PO Daily DOSE MODIFICATIONS: Recommended for neutropenia and thrombocytopenia. Refer to the lenalidomide monograph in the Pharmacology Section. Reference: List A, et al. N Engl J Med 2006;355:1456 - 65. Last Updated on September 24, 2007 .