How I Treat Patients with Lower Risk Myelodysplastic Syndrome

Patients with myelodysplastic syndromes (MDS) are “staged” using clinical algorithms such as the revised International Prognostic Scoring System (IPSS-R), often modified by molecular data. For convenience sake, patients are classified as having lower- or higher-risk disease. Goals for the treatment of lower-risk MDS include minimization of transfusion needs, improvement in patient-reported outcomes, and ultimately lengthening of life. To accomplish these endpoints, patients may opt to receive erythropoiesis stimulating agents, drugs with activity affecting late stages of erythropoiesis such as luspatercept, immunomodulatory drugs, hypomethylating agents, and increasingly agents that target genetic mutations.