Managing anemia in patients with myelodysplastic syndrome (MDS) is complex. When are erythroid growth factors used as primary treatment? — Catherine Rossi, RN III, OCN, York, PA.

Treatment for patients with MDS is multifactorial, involving age, treatment preferences, IPSS scoring, performance status, any antecedent hematologic disorders, and the availability of HLA-matched stem cell donors (Harrison’s Manual of Oncology. 2008;289-303). For those with low-grade MDS and anemia, low or int-1 risk, according to NCCN guidelines, therapy is guided by cytogenetic status ( Erythroid growth factors are used as initial treatment when serum epoetin levels are 500 mU/ml or less, the patient is transfusion independent, and there are no 5q deletion or other cytogenetic alterations (Harrison’s Manual of Oncology. 2008;289-303). — Jiajoyce R. Conway, DNP, FNP-BC, NP-C