Abstract
Background Myelodysplastic Syndrome (MDS) treatments reduce transfusion dependence, delay progression to acute leukemia, and may improve survival. The Canadian Consortium on MDS (CCMDS) developed the MDS ClearPath, a comprehensive tool for the diagnosis, work-up and management of MDS of any risk category at any point during a patient’s disease course. Methods The draft ClearPath algorithm was revised by 60 Canadian hematologists, finalized by consensus of the Steering Committee and went live in 2013. The update went online in January 2023. Results An approach to the diagnosis and management of MDS is provided. Appropriate investigations are detailed, current scoring systems are included as is a prognostic calculator, and an IPSS-M calculator link is included. Treatments (erythropoiesis-stimulating agents; lenalidomide; hypomethylating agents; immunosuppressive therapy; supportive care [transfusions; antibiotics; bleeding prevention; iron chelation]; investigational agents; links to clinical trial websites) are detailed, including dosing/administration; monitoring; dose adjustments; expected response; side effect management; and provincial reimbursement. Added were details on luspatercept, decitabine and decitabine/cedazuridine; recommendations for mutation analysis; WHO and ICC 2022 classifications; the IPSS-M and Clinical Frailty scores; familial predisposition testing; and response assessment criteria. Recommendations are made where data are lacking. The Treatment Wizard, a series of questions specific to clinical status, leads to treatment recommendations; the self-directed mode is the overall algorithm. References with abstract links are included, and information panels included throughout. The ClearPath in English or French is available at www.MDSClearPath.org; a (free) iPad app is being updated. Discussion The CCMDS presents an internet/app-based algorithm to support MDS management, with recommendations designed to assist in the standardization of MDS care.
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