Treatment options for lower-risk myelodysplastic syndromes. Where are we now?

Myelodysplastic syndromes (MDS) are a spectrum of clonal stem-cell disorders characterized clinically by bone-marrow failure. Resultant cytopenias responsible for significant mortality and decreased quality life in patients with MDS. In low-risk MDS (LR-MDS), anemia is the most common cytopenia erythropoiesis-stimulating agents (ESA) usually used as first-line therapy. Those who become refractory to ESA have poor survival. Available treatment options such lenalidomide, hypomethylating agents, immunosuppressive therapy can provide some hematologic response among selected subsets patients, however durable responses limited, these carry adverse effects. Chronic transfusions help alleviate symptoms but still risks associated transfusion iron overload. Luspatercept, recently approved those LR-MDS ring sideroblasts ESA, was found an improvement independence well-tolerated safety profile. While cytopenia, thrombocytopenia neutropenia management challenging co-occurrence may dictate choice this article, we review discuss optimal use current explore new therapeutic on horizon.