Dr. Sekeres on Staging Low- Versus High-Risk MDS

Mikkael A. Sekeres, MD, vice-chair for Clinical Research and director of the Leukemia Program at Cleveland Clinic Taussig Cancer Institute, discusses staging patients with myelodysplastic syndromes (MDS).

When considering available treatments for patients with MDS, the first thing to examine is whether they have lower- or higher-risk disease, says Sekeres. This is done through the use of the International Prognostics Scoring System (IPSS), particularly the revised version, which is generally the default staging system for MDS. This process used to be fairly straight forward: A patient’s risk assessment was based on their blood counts, blast percentage in their bone marrow, and their cytogenetics, explains Sekeres. Patients who have a lot of cytopenias also have a relatively high blast percentage of above 5%, but this can be up to 19%, Sekeres notes. Those who have poor-risk cytogenetics, particularly those who have complex cytogenetics, fall into higher-risk categories. 

Now, molecular typing has thrown a wrench into the system, according to Sekeres. Patients who might be classified as having lower-risk MDS using the IPSS or its revised version could have poor-risk molecular profiles that might include, for example, p53.

With higher-risk MDS, no matter how it is defined, the standard of care is usually a hypomethylating agent (HMA), which can be either azacitidine or decitabine, says Sekeres. More recently, an oral version of decitabine has been approved and appears to have activity that is equivalent to azacitidine or decitabine. However, no head-to-head comparisons have been made among the available HMAs, concludes Sekeres.