From the Guidelines
For Myelodysplastic syndrome (MDS), you should consult a hematologist or hematologic oncologist who specializes in blood disorders and blood cancers. These specialists have the expertise to properly diagnose, stage, and manage MDS, which is a complex group of bone marrow disorders characterized by ineffective blood cell production. The hematologist will likely perform or order a bone marrow biopsy and aspirate, cytogenetic testing, and molecular studies to determine the specific subtype of MDS, assess risk using scoring systems like IPSS-R (Revised International Prognostic Scoring System), and develop an appropriate treatment plan, as recommended by the NCCN clinical practice guidelines in oncology 1.
Key Considerations
- The hematologist will consider factors such as patient age, performance status (PS), and presence of comorbidities to determine the best course of treatment, as these factors have a major influence on the patient’s ability to tolerate certain intensive treatments 1.
- Treatment options may include supportive care with blood transfusions and growth factors like erythropoiesis-stimulating agents (ESAs), disease-modifying agents such as hypomethylating agents (azacitidine or decitabine), lenalidomide for those with deletion 5q, or consideration of allogeneic stem cell transplantation for eligible patients with higher-risk disease, as outlined in the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of MDS 1.
- Regular follow-up with your hematologist is essential as MDS can progress over time, sometimes evolving into acute myeloid leukemia, requiring adjustments to your treatment plan.
Treatment Approach
- The therapeutic approach for MDS should be individualized based on the patient's risk category, with lower-risk patients focusing on hematologic improvement and higher-risk patients aiming for alteration of the disease natural history, as recommended by the NCCN guidelines 1.
- The ESMO guidelines provide specific recommendations for treatment, including the use of azacitidine in patients with higher-risk MDS, AML-like chemotherapy for fit patients with favorable cytogenetics, and allogeneic stem cell transplantation for eligible patients with higher-risk disease 1.
Quality of Life
- The treatment plan should also consider the patient's quality of life, with a focus on improving symptoms and reducing the risk of complications, as emphasized in the NCCN guidelines 1.
- The ESMO guidelines recommend the use of erythropoiesis-stimulating agents (ESAs) for the first-line treatment of anemia in lower-risk MDS, and lenalidomide for patients with deletion 5q, to improve quality of life and reduce the need for transfusions 1.
From the Research
Healthcare Professionals for MDS Consultation
A patient with Myelodysplastic Syndrome (MDS) should consult the following healthcare professionals:
- Hematologist: a doctor who specializes in the diagnosis and treatment of blood disorders 2, 3, 4, 5, 6
- Oncologist: a doctor who specializes in the treatment of cancer 2, 3, 4, 5, 6
- Bone Marrow Transplant Specialist: a doctor who specializes in bone marrow transplants, which may be a treatment option for some patients with MDS 2, 4, 5, 6
Additional Support
Patients with MDS may also benefit from consulting with other healthcare professionals, including:
- Primary Care Physician: a doctor who provides routine medical care and can help coordinate treatment 2, 3, 4, 5, 6
- Nurse Practitioner or Physician Assistant: a healthcare professional who can provide support and guidance throughout treatment 2, 3, 4, 5, 6
- Social Worker or Counselor: a professional who can provide emotional support and help patients cope with the challenges of MDS 2, 3, 4, 5, 6
Specialized Care
In some cases, patients with MDS may require specialized care from professionals such as: