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SEER Inquiry System - Report
Produced: 09/16/2026 1:13 AM
Question 20260019
Inquiry Details
References:
#1: Heme & Lymph Manual & DB. October 2025 update
#2: SEER*Rx
Question:
Immunotherapy--Heme & Lymphoid Neoplasms: Should Anti-Thymocyte Globulin (ATG)/Cyclosporine/Prednisone be coded for myelodysplastic dysplastic syndrome (MDS) and if so, how should it be coded? See Discussion.
Discussion:
Patient failed treatment with Azacitidine for MDS with multilineage dysplasia (9985/3) diagnosed 1/2024, and on re-biopsy of bone marrow 11/2025, histology is now MDS with excess blasts (9989/3). These diagnoses are the same primary using the Hematopoietic and Lymphoid Neoplasms (Heme) Database. The physician has prescribed treatment of Anti-Thymocyte Globulin (ATG)/Cyclosporine/Prednisone. SEER*Rx Database says not to code as ATG and Cyclosporine are antirejection medications post-transplant, but the oncologist is using this combination for treatment.
Answer:
Code ATG/Cyclosporine as biological response modifier (BRM)/Immunotherapy as first course of treatment using the current Heme Manual. Based on changes to the 2026 Heme rules for coding treatment, heme and lymphoid neoplasms are now treated differently than Solid Tumors when it comes to treatment failure.
It can be used for treatment of selected MDS cases particularly those with low-risk disease, HLA-DR15 histocompatibility type, bone marrow hypoplasia. Prednisone should not be coded as it is not disease modifying agent in MDS. It is usually given to reduce/treat infusion reactions/serum sickness associated with ATG infusion.
We will update SEER*Rx.
