Comparing the ICC and WHO classifications for MDS and their impact on clinical practice
Mar 24, 2023
auto_awesome
Experts Amer Zeidan and Sanam Loghavi discuss the updated ICC and WHO classifications for MDS. They explore the overlap and differences between the two systems and highlight the challenges in classifying MDS. The podcast also emphasizes the importance of a comprehensive report and the potential of AI in generating such reports. The significance of a uniform classification for MDS and its impact on clinical practice is highlighted, along with the need for improved treatments. Lastly, the podcast emphasizes the importance of providing accurate patient education resources and recognizing genetic abnormalities morphologically.
The WHO and ICC classifications for MDS differ in their inclusion of genetically and morphologically defined categories, highlighting the need for a unified system.
The classification of MDS impacts clinical practice by influencing patient eligibility for clinical trials and reimbursement for treatments, emphasizing the importance of accurate diagnosis.
Deep dives
Evolution of Classification Systems for MDS
The podcast discusses the evolution of classification systems for myelodysplastic syndromes (MDS) from the French-American, British (FAB) system to the World Health Organization (WHO) and International Consensus Classification (ICC). The FAB system was based on blast percentages, while the WHO and ICC classifications incorporate genetic definitions. The 2016 WHO classification introduced genetic criteria and recognized distinct MDS categories based on gene mutations. The speaker emphasizes the importance of recognizing that patient care extends beyond the pathology report, as the classification impacts eligibility for clinical trials and reimbursement for treatments.
Updates in the 2022 WHO and ICC Classifications
The podcast highlights the major changes in the 2022 WHO and ICC classifications for MDS. The WHO classification includes MDS with genetically defined abnormalities, such as isolated deletion 5Q and MDS with SF3B1 mutation. It also recognizes morphologically defined MDS entities based on blast count and dysplasia. The ICC classification has similar categories but some subtle differences, such as classifying MDS with increased ring sideroblasts as a separate sub-entity. The speaker acknowledges the challenges of having two classifications and the need for a unified system that benefits all patients.
Implications of the Two Classification Systems
The podcast explores the downstream implications of having two different classification systems for MDS in terms of clinical care and clinical trials. It discusses challenges faced by physicians in adopting and implementing the classifications in practice, especially in community settings with limited resources. The speaker suggests that future efforts should focus on harmonizing the systems and leveraging artificial intelligence (AI) to generate comprehensive reports integrating morphology and genetic information. Standardized patient education resources are also recommended to address the evolving classifications.
Efforts Towards a Unified Classification
The podcast describes ongoing efforts to compare and validate the WHO and ICC classifications for MDS. Collaboration between institutions and multi-center datasets are being utilized to evaluate the prognostic implications and clinical utility of the different classification criteria. The goal is to generate evidence-based recommendations that can lead to a harmonized classification system. The speaker emphasizes the importance of classifying MDS based on biology and recognizing distinct molecularly defined groups. They also address the challenges of assigning classifications in practice and propose a unified approach based on genetics, blast count, and dysplasia.
Recently, the International Consensus Classification (ICC) and World Health Organization (WHO) classification systems for myelodysplastic syndromes (MDS) were updated and published. Although these two systems are similar, there are key differences which must be taken into consideration by clinicians when diagnosing patients.
In this podcast, experts Amer Zeidan, MBBS, Yale University and Yale Cancer Center, New Haven, CT, Sanam Loghavi, MD, The University of Texas MD Anderson Cancer Center, Houston, TX, Rami Komrokji, MD, and Somedeb Ball, MD, Moffitt Cancer Center, Tampa, FL, discuss the latest updates in the classification of MDS and share some insights into how these may impact clinical practice.