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Opinion|Videos|December 23, 2025

Understanding MDS: Disease Biology, Risk Stratification, and Treatment Goals

Fact checked by: Amer Zeidan, MBBS, MHS, Rami Komrokji, MD, Michael Savona, MD

Myelodysplastic syndromes (MDS) are a group of clonal bone marrow disorders driven by ineffective hematopoiesis, genetic mutations, and progressive marrow failure. These underlying disease processes lead to chronic cytopenias, increased infection and bleeding risk, transfusion dependence, and, in some patients, progression to acute myeloid leukemia—significantly impacting both survival and quality of life. Risk stratification plays a central role in guiding management, with tools such as prognostic scoring systems used to categorize patients as lower- or higher-risk based on cytogenetics, marrow blasts, and blood counts. Treatment goals differ across these groups: in lower-risk MDS, the focus is on improving cytopenias, reducing transfusion burden, and maintaining quality of life, while higher-risk disease emphasizes altering disease course, delaying progression to AML, and extending survival.

Episodes in this series

3 experts are featured in this series.

EP. 1 Understanding MDS: Disease Biology, Risk Stratification, and Treatment Goals

3 experts are featured in this series.

EP. 2 Historical Management of Low-Risk MDS and the Role of Supportive Care

3 experts are featured in this series.

EP. 3 Optimizing Anemia Management in Low-Risk MDS: From ESAs to Targeted Therapies

3 experts are featured in this series.

EP. 4 Managing Luspatercept Toxicities and Determining When to Switch Therapy in Low-Risk MDS

3 experts are featured in this series.

EP. 5 Targeting Telomerase in Low-Risk MDS: The Role of Imetelstat

3 experts are featured in this series.

EP. 6 Interpreting IMerge Subgroup Analyses and Managing Imetelstat Safety

Myelodysplastic syndromes (MDS) are a group of clonal bone marrow disorders driven by ineffective hematopoiesis, genetic mutations, and progressive marrow failure. These underlying disease processes lead to chronic cytopenias, increased infection and bleeding risk, transfusion dependence, and, in some patients, progression to acute myeloid leukemia—significantly impacting both survival and quality of life. Risk stratification plays a central role in guiding management, with tools such as prognostic scoring systems used to categorize patients as lower- or higher-risk based on cytogenetics, marrow blasts, and blood counts. Treatment goals differ across these groups: in lower-risk MDS, the focus is on improving cytopenias, reducing transfusion burden, and maintaining quality of life, while higher-risk disease emphasizes altering disease course, delaying progression to AML, and extending survival.

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BURST CME™ Resource Center: Integrating Novel PSMA-Directed Radioligand Approaches for Diagnosis and Management of Prostate Cancer

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Working Together: Overcoming Barriers to Optimize Outcomes in Patients Treated With Radioligand Therapy Through Multidisciplinary Care

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21st Annual New York Lung Cancers Symposium®

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Community Practice Connections™: Optimizing SCLC Treatment Strategies and Managing Adverse Events Across Disease Stages

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