A suggested treatment algorithm for myelodysplastic syndrome (MDS)

A suggested treatment algorithm for myelodysplastic syndrome (MDS) - Flowchart Myelodysplastic Syndrome Myelodysplastic Syndrome

«Flowchart»

MDS conventional treatment algorithm

Patient assessment; MDS diagnosis confirmed and classified by WHO system; risk stratification using IPSS-R [consider clinical trial enrollment at all stages]

Patient assessment; MDS diagnosis confirmed and classified by WHO system; risk stratification using IPSS-R [consider clinical trial enrollment at all stages] Patient assessment; MDS diagnosis confirmed and classified by WHO system; risk stratification using IPSS-R [consider clinical trial enrollment at all stages]

Lower-risk disease (e.g., IPSS Low or Int-1, IPSS−R Very Low or Low)

Lower-risk disease Lower-risk disease

Higher-risk disease (e.g., IPSS Int-2 or High, IPSS−R High or Very High)

Higher-risk disease Higher-risk disease

Observe until worse

End

FAIL

sEPO <500 U/L

sEPO 500 U/L

sEPO >=500 U/L

ESA ± G-CSF

Lenalidomide

FAIL

HMA or IST or lenalidomide or TSA

FAIL

AlloSCT or supportive care

FAIL

del(5q)

Non del(5q)

Asymptomatic and mild CBC abnormality

Asymptomatic

Symptomatic anemia, or at risk for transfusion

Symptomatic

Other cytopenias besides anemia dominate

Other cytopenias

HMA

AlloSCT (consider HMA as “bridge”)

AlloSCT candidate

AlloSCT

Not an alloSCT candidate

Not an alloSCT

FAIL

Supportive care

FAIL