Historical Management of Low-Risk MDS and the Role of Supportive Care

Before the availability of FDA-approved therapies specifically for low-risk myelodysplastic syndrome (MDS), management was largely focused on supportive care aimed at alleviating symptoms rather than modifying disease course. Treatment strategies primarily addressed cytopenias, particularly anemia, through red blood cell transfusions and, in selected patients, erythropoiesis-stimulating agents. While these approaches improved quality of life and reduced symptom burden, they did not alter the underlying biology of the disease. Supportive care measures such as transfusions offer rapid symptomatic relief but can lead to cumulative complications, including iron overload, transfusion reactions, and increased healthcare utilization. Iron chelation therapy may mitigate iron-related organ damage in transfusion-dependent patients, but its use is limited by tolerability, adherence challenges, and uncertainty around long-term outcomes. Overall, these limitations underscored the unmet need for targeted, disease-directed therapies in low-risk MDS.