Adult Myelodysplastic Syndromes Clinical Practice Guidelines (BSH, 2021)

British Society for Haematology

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

October 04, 2021

Updated guidelines on the management of adult myelodysplastic syndromes (MDS) were published in July 2021 by the British Society for Haematology (BSH) in the British Journal of Haematology.[1]

Manage anemia with erythropoiesis-stimulating agents (ESAs).

Use iron chelators for transfusion-related iron overload.

In patients with transfusion-dependent MDS with isolated del(5q) who experience failure or unresponsiveness to ESA therapy, lenalidomide is recommended.

In lower-risk MDS, transplantation is recommended for patients with any of the following:

  • Transfusion dependency (≥2 units of blood/month)

  • Significant cytopenias (platelets < 30 × 109/L, neutrophils < 0.3 × 109/L)

  • Adverse cytogenetics

Transplantation should possibly be considered at an early stage before iron overload occurs, or after failure of ESA or lenalidomide treatment, in particular if TP53 mutation coexists with del(5q), or if fibrosis is present.

In higher-risk MDS, upfront transplantation is recommended if bone marrow blasts are 5-10%, with hypomethylating agents given before transplantation if blasts are > 10%.

In patients who are potential transplantation candidates, screen for mutations of the TP53, RAS, JAK2, DNMT3A, TET2, ASXL1, and RUNX1 genes, which correlate with poorer outcomes.

Enroll patients with biallelic TP53 mutations associated with a monosomal karyotype in a clinical trial, as conventional treatments provide very poor response and survival.

Selected older patients (> 70 years) with high-risk MDS who have good performance status and a low transplantation-specific comorbidity index should be presented as candidates for allogeneic transplantation.

For conditioning before transplantation, myeloblative conditioning is recommended in high-risk patients with good performance status and no comorbidities. Reserve reduced-intensity conditioning for older, less-fit patients.

For more information, please go to Myelodysplastic Syndrome (MDS). For more Clinical Practice Guidelines, please go to Guidelines

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