The myelodysplastic syndromes (MDS) represent a heterogenous group of myeloid clonal hemopathies with variable disease trajectories and prognosis. The diagnostic criteria and classifications systems have evolved over the last 15 years to include morphologic and molecular attributes that differentiate each subtype of the disease. These points were discussed in an oral presentation at the 2023 ONA Summit Live Virtual Meeting.
Most recently, the World Health Organization published the 5th Edition of the classification system for hematolymphoid tumors, including MDS. This update introduces the term myelodysplastic neoplasms (also abbreviated MDS) to replace myelodysplastic syndromes, underscoring the neoplastic nature of these diseases and aligning the nomenclature with myeloproliferative neoplasms (MPNs). Each subtype carries prognostic significance with variable risks of transformation to acute myeloid leukemia (AML).
The International Prognostic Scoring System–Molecular (IPSS-M) has also recently been published, adding the prognostic significance of driver mutations to the well-established IPSS-R that includes cytogenetics, cytopenias, age, and blast count. Profiling MDS in this way drives treatment decision making and offers the best strategy to seek out the most effective therapy for individual patients.
Allogeneic stem cell transplantation remains the only potential cure. Most patients with MDS are older than 70 years, have comorbidities, and are taking medication. A majority of older patients will not be eligible for transplantation. Establishing the goals of care early in the treatment planning process is critical to limiting morbidity and mortality.
Understanding each treatment option, potential risks and benefits, treatment requirements, and expected duration of treatment will assist in shared decision making. Once treatment has been selected, prevention, mitigation, and management of disease and treatment-related adverse events is key.
Although there are common adverse events across disease modifying agents used to treat MDS, each currently approved drug has unique safety considerations. Concurrent supportive and palliative care should be applied to all patients with MDS.
Sandra Kurtin is director, Advanced Practice and Clinical Integration, the University of Arizona Cancer Center, and clinical assistant professor of medicine, adjunct clinical professor of nursing at the University of Arizona, in Tucson.
Kurtin SE. Challenges and opportunities: MDS/MDN diagnosis, treatment, and symptom management. Oral presentation at: 2023 ONA Summit Live Virtual Meeting; March 17-19, 2023.