Classifying MDS: Updated WHO and ICC Guidelines

Opinion
Video

Drs Safah and Koprivnikar review updates made to the WHO and ICC guidelines when classifying MDS as well as discussing the impact of molecular alterations when treating MDS.

This is a video synopsis/summary of a Precision Medicine series featuring Hana Safah, MD, and Jamie Koprivnikar, MD. Safah and Koprivnikar discuss recent updates to myelodysplastic syndrome (MDS) classification guidelines by the World Health Organization (WHO) and the International Consensus Classification. They note increased emphasis on genetic and molecular alterations in the pathogenesis and prognosis of MDS subtypes.

New categories have been established, including MDS with deletion 5q as a distinct entity and MDS with SF3B1 mutations, which comprises a homogeneous group with favorable outcomes. The WHO also recognizes MDS with ring sideroblasts whether SF3B1 mutated or not. Both organizations highlight the poor prognosis of MDS with biallelic TP53 mutations leading to loss of function.

A key addition is the International Committee for Standardization of Hematology’s introduction of MDS/acute myeloid leukemia (AML) type for patients with 10% to 20% blasts, allowing them to be treated as AML if suitable. This enables more precise diagnosis and personalized treatment selections. Ongoing harmonization between guidelines will facilitate clearer clinical trial eligibility and translation of evidence into practice.

Even within prognostic subgroups, heterogeneity exists. Continued refinement should improve risk stratification and identify candidates for transplant vs conservative management.

Video synopsis is AI generated and reviewed by Targeted Oncology editorial staff.

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