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.
In the first segment of the series, the panel describes recent trends in the classification and prognosis of MDS in the clinic.
Dr. Zeidan: What is your current approach to classifying, as well as prognosticating, for a patient when you see someone new in the clinic?
Dr. Swoboda: Recently, the classification for MDS has changed a lot because now we not only have the World Health Organization (WHO) classification system, we also have the International Consensus Classification (ICC) system, which helps define MDS better but also makes things more complex for investigators and patients.
Some of the big changes with those two classification systems are more molecular-based classifications. SF3B1-mutant MDS is its own separate subtype. TP53-mutant MDS, whether it’s just MDS with TP53 or, in the WHO system, biallelic TP53, is its own subset. The ICC is now moving into more of an “MDS/[acute myeloid leukemia]” category for patients who have 10% to 20% blasts. Those are the biggest changes.
We are starting to move into a more molecular-based classification system, and that also works its way into prognosis. Until recently, we thought about prognosis based on the chromosomal makeup of the disease, the blood counts, the amount of leukemia cells that an MDS patient had. Now, we’ve added a molecular component with the update of the [Molecular International Prognostic Scoring System].
That addition really helps to better define the different subsets of MDS. We now have six subsets: very low, low, moderately low, moderately high, high, and very high. All across MDS, whether it’s diagnosis, prognosis, or treatment, we’re now really incorporating molecular into what we’re doing.