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Cited by 187

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Myelodysplastic syndromes: 2021 update on diagnosis, risk stratification and management

Garcia‐Manero, Guillermo, Chien, Kelly S., Montalban‐Bravo, Guillermo·2020·American Journal of Hematology

Abstract

Disease overview: The myelodysplastic syndromes (MDS) are a very heterogeneous group of myeloid disorders characterized by peripheral blood cytopenias and increased risk of transformation to acute myelogenous leukemia (AML). Myelodysplastic syndromes occur more frequently in older males and in individuals with prior exposure to cytotoxic therapy. Diagnosis: Diagnosis of MDS is based on morphological evidence of dysplasia upon visual examination of a bone marrow aspirate and biopsy. Information obtained from additional studies such as karyotype, flow cytometry and molecular genetics is usually complementary and may help refine diagnosis. Risk‐stratification: Prognosis of patients with MDS can be calculated using a number of scoring systems. In general, all these scoring systems include analysis of peripheral cytopenias, percentage of blasts in the bone marrow and cytogenetic characteristics. The most commonly accepted system is the Revised International Prognostic Scoring System (IPSS‐R). Somatic mutations can help define prognosis and therapy. Risk‐adapted therapy: Therapy is selected based on risk, transfusion needs, percent of bone marrow blasts, cytogenetic and mutational profiles, comorbidities, potential for allogeneic stem cell transplantation (alloSCT) and prior exposure to hypomethylating agents (HMA). Goals of therapy are different in lower‐risk patients than in higher‐risk individuals and in those with HMA failure. In lower‐risk MDS, the goal is to decrease transfusion needs and transformation to higher risk disease or AML, as well as to improve survival. In higher‐risk disease, the goal is to prolong survival. In 2020, we witnessed an explosion of new agents and investigational approaches. Current available therapies include growth factor support, lenalidomide, HMAs, intensive chemotherapy and alloSCT. Novel therapeutics approved in 2020 are luspatercept and the oral HMA ASTX727. At the present time, there are no approved interventions for patients with progressive or refractory disease particularly after HMA‐based therapy. Options include participation in a clinical trial, cytarabine‐based therapy or alloSCT.

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Metadata

Authors
Garcia‐Manero, G., Chien, K. S., & Montalban‐Bravo, G.
Venue
American Journal of Hematology
Publisher
Wiley
Published
2020-10-17
Volume
95
Issue
11
Pages
1399-1420
ISSN
  • 0361-8609 (ISSN-L)
  • 1096-8652
OpenAlex
W3047204205
Cited by
187
References
21
FWCI
17.01
Type
journal article
Language
en
Open access
closed

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CoChat. (2026). Citation check: Myelodysplastic syndromes: 2021 update on diagnosis, risk stratification and management. https://app.cochat.ai/papers/10.1002/ajh.25950
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Garcia‐Manero, G., Chien, K. S., & Montalban‐Bravo, G. (2020). Myelodysplastic syndromes: 2021 update on diagnosis, risk stratification and management. American Journal of Hematology. https://doi.org/10.1002/ajh.25950

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