Myelodysplastic Syndromes (MDS); diagnosis, classification, treatment and monitoring

Abstract

Due to the neoplastic nature of myelodysplastic syndromes (MDS), they have been renamed as myelodysplastic neoplasms in the World Health Organization (WHO) 2022 classification. These syndromes are heterogeneous groups of myeloid disorders characterized by dysplasia of bone marrow cells, ineffective hematopoiesis, increased apoptosis, peripheral blood cytopenia, and risk of progression to acute myeloid leukemia (AML). The recent progress in understanding the pathogenesis of these diseases is due to the emergence of next-generation sequencing (NGS) and the simultaneous interpretation of changes in cell morphologies, cytogenetics, and molecular mutations, which have provided the conditions for better classification and determination of efficient prognosis. Based on the Revised International Prognostic Scoring System (IPSS-R) system, MDS treatment approaches were divided into two groups: low-risk MDS, and high-risk MDS. In low-risk MDS, MDS is not the main cause of death, and most of the patients die as a result of cytopenia and the quality of life. Therefore, the goal of treatment approaches in low-risk MDS is to improve the quality of life in patients. However, in patients with high-risk MDS, the possibility of progression to AML is life-threatening. Therefore, clinical decisions aim to improve the course of the disease.