Treatment of lower-risk MDS

This algorithm describes management of lower-risk MDS, which we define as IPSS-R ≤3.0 points or IPSS 0 to 1 points; some patients with intermediate-risk IPSS-R may also be considered to have lower-risk MDS. Refer to related UpToDate topics for discussion of diagnosis, classification, prognostic scoring systems, pretreatment evaluation, drug doses/regimens, and assessment of response to therapy.

MDS: myelodysplastic syndromes; Hgb: hemoglobin; EPO: erythropoietin; TPO-RA: thrombopoietin receptor agonist; ESA: erythropoiesis-stimulating agent; del(5q): deletion of chromosome 5q; IDH: isocitrate dehydrogenase; IST: immune suppressive therapy; IPSS-R: international prognostic scoring system - revised; IPSS: international prognostic scoring system; PNH: paroxysmal nocturnal hemoglobinuria; HMA: hypomethylating agent (eg, azacitine, decitabine).
* Consider repeat bone marrow examination if worsening cytopenias are accompanied by increasing blast count or other worrisome findings.
¶ Continued need for transfusions may cause alloimmunization, iron overload, or other complications; consider treatment with lower intensity agents if such complications arise.
Δ Factors associated with higher likelihood of response to IST include: age <60 years with ≤5% blasts, hypocellular bone marrow, PNH-positive clones, or STAT3-mutant T cell clones.
◊ We suggest not treating with a second HMA, if initial response to azacitidine or decitabine was insufficient.

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Treatment of lower-risk MDS