Classification Systems for MDS


Distinguished experts in hematology discuss the WHO and ICC classification systems for myelodysplastic syndromes (MDS), including recent WHO updates.


Rami Komrokji, MD: Hello, and welcome to this Targeted Approaches in Myelodysplastic Syndromes and Myelofibrosis American Society of Hematology (ASH) 2022 Update. I'm Rami Komrokji, vice chair of malignant hematology at Moffitt, joined by my dear friend and colleague, Dr Amer Zeidan, from Yale University. We're going to provide some updates on both myelodysplastic syndromes and myelofibrosis, as we just came back from ASH 2022. Amer, I'll start by asking you to provide us with an update on a hot topic in myelodysplastic syndromes (MDS) that was discussed in many presentations at ASH, including classification and risk stratification.

Amer Zeidan, MBBS: Thank you, Rami. It's a pleasure to be with you, and it certainly has been a very good experience coming back to ASH with crowds being able to interact with colleagues in person after the difficult years of the coronavirus pandemic. One of the interesting aspects of the MDS sessions and abstracts that were presented in this ASH meeting is that there were a large number of abstracts that have focused on validating and comparing some of the new changes that have happened in the field.

Two main areas were the WHO classification for MDS, which started in the year 2001, [and] has been updated several times and the latest iteration was published early in 2022. At the same time, a new classification came from the International Consensus Classification (ICC) group. And while there is some overlap, there are areas that are somewhat different between the two classifications. There is some growing concern within the field about some discrepancies between the two entities and confusion that might arise not only on the clinical practice level from patients regarding their diagnoses and implications for treatments, but also in terms of how that extends to clinical trial eligibility, drug approvals, and multiple areas, including registry data and other kinds of administrative type of research.

There are a couple of abstracts that were kind of high-value abstracts. One presentation led by the Moffitt group looked at comparing the 2 systems, basically using a very large data set from the Moffitt Cancer Center. This abstract presented by Dr Boyle was quite interesting because it showed that there are certain aspects of each classification that seem to work well, but not all of the aspects. This probably suggests that some tweaking of those classifications is needed. At the end of the day, harmonization of the 2 classifications is going to become very important because we need to deliver one consistent message to patients. There is ongoing discussions in the field and I'm very hopeful that this is going to happen.

Transcript edited for clarity.

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