What Major Themes Define Recent Lower-Risk MDS Prognostication, Treatment?

In a series of roundtable discussions, an expert panel moderated by Jamile Shammo, MD, of Northwestern University, explored current issues in myelodysplastic syndrome (MDS) care. The panel included David Swoboda, MD, of Tampa General Hospital; Saeed Sadeghi, MD, of the David Geffen School of Medicine; and Christopher Benton, MD, of Rocky Mountain Cancer Centers.

In this segment, the panel discussed recent noteworthy changes in the clinical evaluation and treatment of lower-risk MDS. The incorporation of molecular data to inform disease diagnosis, risk stratification, prognosis, and treatment selection has been most significant.

“I think really with the way that we think about diagnostics and prognostication of MDS, that has changed a lot. Now we’re really focused a lot more on the molecular makeup of MDS, and less on just solely morphologic makeup of the disease,” Dr. Swoboda commented.

The 2022 revisions to the International Consensus Classification (ICC) and World Health Organization (WHO) classification systems for MDS reflect such incorporation of molecular data. The International Prognostic Scoring System-Revised (IPSS-R) for MDS was similarly updated to create the Molecular IPSS (IPSS-M).

“I think it really speaks to moving forward and incorporating the molecular prognostication for these patients because we potentially can identify patients much more accurately in terms of the therapeutics that we’re going to use for them,” Dr. Sadeghi remarked regarding the IPSS update.

The goals the panel raised in the management of lower-risk MDS included improvement of hemoglobin levels and reduction of transfusion need. Newer treatment agents appear to be accomplishing these, though Dr. Benton noted, “even if it’s months or years down the line, [patients] lose their response to these drugs. One of the needs is to extend these responses and ultimately even help reverse the course of the disease.”

The panel highlighted luspatercept and imetelstat as two agents which have recently received regulatory approvals for MDS indications. Clinicians are still learning in what combinations, sequencing, and patients these treatments are best used.