Classification, risk stratification and response assessment in myelodysplastic syndromes/neoplasms (MDS): A state-of-the-art report on behalf of the International Consortium for MDS (icMDS)

Latest Insights and Therapeutic Advances in Myelodysplastic Neoplasms

“…The recognition of dysplastic features is crucial for MDS diagnosis, with the recommended threshold for dysplasia set at 10% for all lineages [2]. Furthermore, CBC counts, myeloblast percentage [30][31][32][33], and karyotype [4,34] have traditionally represented the main clinical and pathological variables contributing to risk stratification [35,36] and allowed for the recognition of some MDS-specific subtypes [16,[37][38][39][40]. Moreover, the clinical significance of BM cellularity and reticulin fibrosis degree [32,33] by immunohistochemistry are now recognized by WHO-5 [1] and the 2022 ICC [2].…”

“…In addition, a useful accuracy in blast counting, other than valuable findings on the pathological immunophenotype features of MDS cell populations, can be provided by multiparametric flow cytometry (MFC), although this methodology has still only a complementary role [29] in this field and it is not yet widely used in MDS diagnosis [41]. Although cytogenetic analysis maintains a fundamental role in the diagnosis and especially prognosis of MDS patients [35,36], with about half of them carrying one karyotype alteration [4,34], recent genomic advances have provided remarkable improvement in this setting [5,42]. Genetic advance have demonstrated at least one oncogenic genomic alteration in 94% of patients with MDS and have lead to the formulation of the Molecular International Prognostic Scoring System (IPSS-M) [42], in which development diagnostic samples from 2957 patients with MDS were profiled for mutations in 152 genes implicated in myeloid neoplasms [42].…”

“…Effective risk stratification is crucial in MDS management, guiding therapy selection based on the risk of transformation into AML. In this regard, MDS patients are categorized into lower-risk (LR) and higher-risk (HR) groups, with expected survival ranging from a few months to over 10 years [12,35,36]. Traditional clinical prognostic scoring systems, such as the International Prognostic Scoring System (IPSS) and its revised version, IPSS-R (Table 2) [56], have been widely used in medical practice and clinical research.…”

Engagement of Mesenchymal Stromal Cells in the Remodeling of the Bone Marrow Microenvironment in Hematological Cancers

“…Myelodysplastic syndromes (MDSs) are generally referred as a heterogenous group of clonal hematopoietic diseases characterized by ineffective hematopoiesis resulting in peripheral blood cytopenia, potentially shifting to acute myeloid leukemia (AML) [65]. MDS patients display different degrees of cytopenia and dysplasia, therefore constituting the basis for the Word health Organization's MDS classification criteria [66]. To date, no clinically effective treatment is available for preventing progression to AML.…”