How Do Clinicians Navigate the Two MDS Classification Systems?

By Amer Zeidan, MBBS, MHS, David Swoboda, MD, Jamie Koprivnikar, MD, Sangeetha Venugopal, MD, Leah Sherwood, Andrew Moreno - Last Updated: June 21, 2024

A roundtable discussion, moderated by Amer Zeidan, MBBS, MHS, of Yale University, focused on the latest updates in the care of myelodysplastic syndromes (MDS). The panel included David Swoboda, MD, of Tampa General Hospital; Jamie Koprivnikar, MD, of Hackensack University Medical Center; and Sangeetha Venugopal, MD, MS, of the Sylvester Comprehensive Cancer Center in Miami.

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In the second segment of the series, the panel describes how having two classification systems for MDS affects their clinical practices.

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Dr. Zeidan: This issue of the different classification systems has certainly caused a lot of uproar in the community. There are, I would say, largely negative feelings about having two different classification systems.

How have you been navigating this with your patients and in your collaborations with the pathologists at your institution?

Dr. Koprivnikar: That’s a great question, and I’m hoping that the community is going to start to embrace this new classification system. I am certainly adopting it in my practice, although some of the clinical trials that we’re enrolling patients on are still using some of the more traditional, or should we say outdated, classification systems.

We’ve had conversations with our pathologists. They are well aware of these new classifications, and I think for those of us who have been treating this disease for a long time, this is intuitive. I think we’ve always understood that a patient with a tumor protein 53 mutation, complex cytogenetics, and 12% blasts acts like acute myeloid leukemia (AML) rather than MDS. So for those of us in the community who have spent a lot of time treating this disease, this is intuitive. We’re happy to see the classification systems catching up with what we’ve always understood to be inherently true about this disease.

Dr. Zeidan: Do you do this also in your institutions, Sangeeta? Does your pathologist report by both classifications? Do they have the International Consensus Classification (ICC) category and the World Health Organization (WHO) category?

Dr. Venugopal: Yes, that’s correct. If, as Jamie said, it’s 10% blast, we call it oligoplastic AML. Sometimes it’s nucleophosmin 1 (NPM1) MDS and 10% blast. It says this is a different classification for AML, but then the WHO and ICC say that AML with NPM1, regardless of the blast percentage, is AML.

Similarly, with MDS, sometimes what happens is, even with chromosome 5q deletion (del5q), when it is present with splicing factor 3B subunit 1 (SF3B1) [mutation] and del5q, then it becomes an issue because these are separate classifications. So, MDS with del5q is a defined entity and MDS with SF3B1 [mutation] is a defined entity. In that case, I don’t know what to do because most of the time what the pathologist says is, “Okay, according to ICC, this is what it is, and this is what it is according to the WHO.”

Dr. Zeidan: Yes, in my experience it has been important to have good communication with both the pathologist and the patients.

I was always struck by the fact that some patients, for example, are so focused on not having their MDS develop into AML. This is their top priority. Even when the blast count is 18% or 19%, they are so focused on not crossing the 20%.

It was very important to make sure that some of these artificial divisions between the diseases are not emphasized to the patient. Having that “MDS/AML” category does have its own advantages.

Post Tags:HOPLive24-MDS
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