1. Use the following CASE to answer questions 1 through 3:
JK is a 54-year-old man with complaints of increasing fatigue and shortness of breath on exertion. His complete blood count reveals a hemoglobin of 8.7 g/dL, platelet count of 10 x 109/L, and neutrophil count of 2.1 x 109/L. Bone marrow biopsy consistent with refractory anemia with 28% ring sideroblasts, 1% bone marrow blasts, and no blasts in peripheral blood. Cytogenetics reveal del(11q). His serum erythropoietin level is 617 mU/mL. JK is diagnosed with myelodysplastic syndrome.

What is JK’s predicted overall survival based on the International Prognostic Scoring System- Revised (IPSS-R)?

2. JK's physician orders next-generation sequencing (NGS) and results reveal EZH2, DNMT3A, TET2, and SF3B1 mutations. Which of the mutations present in JK's NGS is associated with an improvement in overall survival?

3. Which of the following therapies is most appropriate for managing anemia in JK?

4. Use the following CASE to answer questions 4 through 6:
LP is a 69-year-old man who presents to his primary care physician with complaints of dull chest pain for the past several weeks. Evaluation reveals a hemoglobin of 6.2 g/dL, platelet count of 223 x 109/L, and neutrophil count of 4.5 x 109/L. Bone marrow biopsy is consistent with myelodysplastic syndrome with an isolated del(5q). He has no somatic mutations on next-generation sequencing. He has no ring sideroblasts or blasts in his bone marrow or peripheral blood. His serum erythropoietin level is 712 mU/mL.

What is LP’s predicted overall survival based on the International Prognostic Scoring System- Revised (IPSS-R)?

5. Which of the following is the most appropriate initial treatment to manage anemia in JK?

6. Which of the following findings presents the greatest risk for LP if he chooses to manage his anemia solely with red blood cell transfusions?

7. Use the following CASE to answer questions 7 and 8:
HF is a 78-year-old woman with a history of atrial fibrillation and hypertension. Her heart rate is well controlled on diltiazem, and she receives anticoagulation with apixaban. Over the past few months, she has noticed progressive fatigue; however, she has avoided visiting her primary care provider because of the COVID-19 pandemic. Evaluation reveals a hemoglobin of 7.9 g/dL, platelet count of 181 x 109/L, and neutrophil count of 3.2 x 109/L. Bone marrow biopsy is consistent with myelodysplastic syndrome with multilineage dysplasia. She has no ring sideroblasts, 2% blasts in the bone marrow, and no blasts in the peripheral blood. Cytogenetics consistent with del(7q). Her serum erythropoietin level is 127 mU/mL.

What is HF’s predicted risk group based on the International Prognostic Scoring System- Revised (IPSS-R)?

8. Which of the following is most appropriate for HF at this time?

9. The Director of Pharmacy has asked you to prepare a presentation on medications to treat MDS for formulary review. Which of the following is most appropriate to include in your presentation?

10. Which of the following is most appropriate to include when counseling patients receiving medications for myelodysplastic syndrome?

Evaluation Questions

11. How confident are in your treatment choice for JK?

12. How confident are in your treatment choice for LP?

13. How confident are in your treatment choice for HF?

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