Imetelstat, as an innovative telomerase inhibitor, offers a new therapeutic option for patients with specific myelodysplastic syndromes.

I. Hematologic Adverse Reactions

1. Recognition and Prevention of Thrombocytopenia

(1) Patients should watch for new petechiae or ecchymoses on the skin, as well as abnormal bleeding such as gingival bleeding or epistaxis.

(2) In daily activities, it is recommended to use a soft-bristled toothbrush and an electric razor, and to avoid bumps and bruises.

(3) If melena, hematuria, or hematemesis occurs, contact the physician immediately.

(4) The physician will assess risk through regular complete blood count monitoring, and arrange platelet transfusions or adjust the dosing regimen when necessary.

2. Infection Prevention in Neutropenia

(1) Patients should monitor body temperature daily and watch for signs of infection such as chills, sore throat, cough, or painful urination.

(2) Preventive measures include frequent hand washing, maintaining oral hygiene, avoiding contact with individuals with colds, and ensuring food is thoroughly cooked.

(3) If fever or suspected infection occurs, seek medical attention promptly. The physician may use granulocyte colony-stimulating factors or anti-infective therapy as appropriate.

3. Monitoring Cooperation During Treatment

(1) Complete blood counts should be performed weekly during the initial treatment phase, and repeated before each dose in subsequent cycles.

(2) This is an important basis for the physician to decide whether to continue treatment, delay dosing, or adjust the dose.

(3) Patients should strictly adhere to the scheduled blood draw times and should not omit tests simply because they feel well.

II. Non-Hematologic Adverse Reactions

1. Observation and Management of Infusion-Related Reactions

(1) Headache, joint and muscle aches, skin flushing, or pruritus may occur during or shortly after the infusion.

(2) To prevent these reactions, premedication with antihistamines or other agents will be administered before each infusion.

(3) If chest tightness, significant blood pressure fluctuations, or severe discomfort occurs during infusion, inform the nurse immediately so that the infusion rate can be adjusted or the infusion paused.

(4) It is recommended to remain under observation in the hospital for at least one hour after the infusion.

2. Management of Liver Function Test Fluctuations

(1) Elevated liver enzyme levels may occur during treatment, but usually without obvious symptoms.

(2) Therefore, regular blood sampling for liver function monitoring is very important.

(3) Patients should avoid alcohol and consult the physician before using other medications (including herbal medicines and dietary supplements) to reduce liver burden.

(4) If liver enzymes rise significantly, the physician will decide whether to hold treatment or adjust the dose accordingly.

3. Relief of Fatigue and Musculoskeletal Discomfort

(1) Patients are advised to arrange daily activities reasonably, engage in mild walking or gentle stretching when energy permits, and avoid prolonged bed rest.

(2) Local heat application, gentle massage, and, if necessary, analgesic medications as prescribed by the physician can help relieve muscle aches.

III. Special Populations and Long-Term Considerations

1. Fertility and Contraceptive Recommendations for Women of Childbearing Age

(1) Animal studies suggest that this drug may cause fetal harm; therefore, women of childbearing potential must have a negative pregnancy test before starting treatment and should use effective contraception during treatment and for one week after the last dose.

(2) If pregnancy is suspected during treatment, inform the physician immediately.

2. Nursing and Pediatric Use Considerations

(1) It is unknown whether the drug is excreted in human milk; therefore, breastfeeding should be suspended during treatment and for one week after the last dose.

(2) The safety and efficacy of this drug in pediatric patients have not been established; it is not indicated for use in children.

3. Fertility and Long-Term Health Concerns

(1) In animal studies, high doses were observed to potentially affect the endometrium in females, but recovery occurred after drug discontinuation.

(2) Patients with fertility desires should fully communicate with their physician before treatment to understand the relevant risks and optional strategies for fertility preservation.

Note: This article cannot replace professional medical advice. For the management of specific adverse reactions, please always follow the individualized guidance of your attending physician.