A multidisciplinary group of experts has authored an updated European Society for Medical Oncology (ESMO) Clinical Practice Guideline, providing recommendations on the management of myelodysplastic syndromes (MDS) based on available scientific data and the authors’ expert opinion, as published in Annals of Oncology.
- Diagnosis is based on blood count, marrow aspirate and marrow karyotype. Bone marrow biopsy is recommended at diagnosis, and molecular biology is useful for diagnosis if blood and marrow tests are inconclusive.
- For prognostic evaluation, the revised international prognostic scoring system (IPSS-R) is required. Molecular analysis may add prognostic value, especially for TP53 and SF3B1 mutations in patients with
- Azacitidine is recommended for patients with higher-risk MDS without major comorbidities and not immediately eligible for allogenic stem cell transplant (allo-SCT).
- Allo-SCT should be proposed to all higher-risk MDS patients
- Erythropoiesis-stimulating agents (especially erythropoietin alpha) are recommended for the first-line treatment of anaemia in lower-risk MDS in patients without del(5q).
Consideration of the patient’s age, performance status, comorbidities, frailty, and desire (after adequate information provided by the medical team) is crucial before making any treatment decision.