Classification, treatment goals, and management principles for myelodysplastic syndromes.

Cancer Control 3 gorizations (eg, the recognition of the negative prognostic import of multilineage dysplasia, even in the absence of excess blasts or with ringed sideroblasts), additional prognostic information is needed for the management of the patient with MDS. The International Prognostic Scoring System (IPSS) provides a framework to guide the caregiver in discussions with the patient and identification of treatment goals.11-13 Created in a study that pooled observational data from numerous longitudinal MDS trials, the IPSS study examined risk factors beyond cell morphology that might be associated with MDS prognosis — specifically, factors that might be useful in predicting the level of risk of progressing to pathologically defined acute myeloid leukemia (AML), ie, ≥30% blasts in the FAB classification. The IPSS score was derived from an analysis of the outcomes of 816 patients with de novo MDS who were enrolled in large institutional or national trials. Centrally reviewed, this analysis produced the world’s largest dataMyelodysplastic syndromes (MDS) constitute a group of acquired clonal stem cell disorders.1 Occurring primarily in persons 65 years of age and older, these conditions are characterized by peripheral cytopenias and dysplasia of bone marrow progenitor cells.2 In later stages of MDS, clonal evolution produces progressive bone marrow failure and progressive accumulation of marrow blasts.3 While management of patients with MDS is challenging, the physician’s armamentarium includes tools to assist in developing an individualized care plan for each patient. The plan of care may be designed to provide palliation, stabilization, or cure. This article reviews current MDS classification and risk stratification tools, general treatment principles and therapy goals, and International Working Group (IWG) criteria to assess clinical response and quality of life parameters.