Practical recommendations for hypomethylating agent therapy of patients with myelodysplastic syndromes

Clinicians commonly administer one or the other of the two hypomethylating agents currently approved in the United States--azacitidine or decitabine--to patients with aggressive forms of myelodysplastic syndromes (MDS). However, there continues to be uncertainty about the optimal choice of agent, the best initial dose and treatment schedule, the role of hypomethylating agents in patients with more indolent disease, the most appropriate management of treatment-associated adverse events, and the most desirable approach to maintain responses. The evidence base supporting clinical decisions around these questions varies widely in depth and quality. This article discusses practical considerations for clinicians who use hypomethylating agents to treat patients with MDS.