Updates on the diagnosis, risk stratification and treatment of lower-risk MDS
Oct 6, 2023
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Sanam Loghavi, medical doctor from The University of Texas MD Anderson Cancer Center, discusses updates on the diagnosis, risk stratification, and treatment of lower-risk MDS. Topics include the challenges in managing LR-MDS, the importance of accurate diagnosis and risk stratification using the IPSS-M model, FDA approval of Luspattersept frontline therapy, constructing pathology reports for optimal patient care, and incorporating various diagnostic tools for diagnosing LR-MDS.
Thorough diagnosis and risk stratification are crucial for managing lower-risk MDS, including comprehensive clinical history and genetic analysis.
Low-risk MDS patients have better overall survival, but still have a risk of transforming to AML, emphasizing the need for accurate risk assessment.
Deep dives
Diagnosis and Risk Stratification of MDS
The podcast discusses the importance of a thorough diagnosis and risk stratification for lower-risk myelodysplastic syndromes (MDS). The speakers emphasize the need for a comprehensive clinical history, as well as key diagnostic tests such as peripheral blood smear, bone marrow biopsy, and flow cytometry. They also highlight the significance of genetic analysis, including cytogenetic abnormalities and somatic mutations. The evolving field of molecular iteration, specifically the IPSSM system, is mentioned as a powerful tool in risk stratifying patients with MDS.
Low Risk vs. High Risk MDS
The podcast explores the distinction between low-risk and high-risk MDS in terms of risk of transformation to acute myeloid leukemia (AML) and overall survival. It is revealed that low-risk MDS patients have a better overall survival and lower likelihood of progression to leukemia, but around 30 percent of all MDS patients, including those labeled as lower risk, may still transform to AML. The speakers note the importance of considering both transformation risk and mortality rate when assessing risk categories.
Treatment Approaches for Low Risk MDS
The podcast highlights the changing landscape of treatment approaches for low-risk MDS. It emphasizes the breakthrough in lower-risk MDS with the FDA approval of Luspatercept, particularly for patients with ringed sideroblasts (RS) or SF3B1 mutation. The speakers discuss the role of erythropoietin (EPO) and Luspatercept in managing anemia in lower-risk MDS patients. They suggest considering Luspatercept earlier for patients with RS-negative, higher mutation burden, or higher endogenous serum erythropoietin levels. The integration of molecular data in pathology reports is also mentioned as a valuable addition for clinicians in determining the most appropriate therapy.
The treatment and management of lower-risk myelodysplastic syndromes (LR-MDS) has remained a challenge in the field, and several studies are being conducted with the goal of improving the understanding of this disease. Furthermore, there have been recent updates to classification systems for MDS, including the Molecular International Prognostic Scoring System (IPSS-M).
In this podcast, you will hear from Sanam Loghavi, MD, The University of Texas MD Anderson Cancer Center, Houston, TX, and Rami Komrokji, MD, Moffitt Cancer Center, Tampa, FL, who discuss recent updates in the diagnosis, risk stratification and treatment of LR-MDS. This discussion was filmed at the Eleventh Annual Meeting of the Society of Hematologic Oncology (SOHO 2023) held in Houston, TX.