This document represents an update of the British Society of Haematology Guideline published in 2014 due to advances in understanding the biology and therapy of the myelodysplastic syndromes (MDS). 1 The objective of these guidelines is to provide healthcare professionals with clear guidance on the management of adult patients with MDS. Individual circumstances may dictate an alternative approach. A separate British Society for Haematology (BSH) guideline covers the Diagnosis and Evaluation of Prognosis of Adult MDS which is published alongside this Guideline. A separate good-practice paper detailing the management of patients with chronic myelomonocytic leukaemia (CMML) will follow and is not considered in these Guidelines.
MethodologyThese Guidelines were compiled according to the BSH process https://b-s-h.org.uk/media/16732/bsh-guidance-deve lopment-process-dec-5-18.pdf. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at http://www.gradeworkinggroup.org.
Literature review detailsThe guideline group was selected to be representative of UK medical experts and the manuscript was reviewed by the UK MDS Patient Support Group. Recommendations are based on a review of the literature using Medline/Pubmed searches. Search terms included: myelodysplasia, MDS, myelodysplastic, refractory an(a)emia, refractory cytopenia, deletion 5q, del(5q), management, treatment, transfusion, supportive care, iron chelation, growth factors, erythropoietin, TPO agonists, thrombopoietin agonists, romiplostim, eltrombopag, immunosuppression, lenalidomide, azacitidine, decitabine, chemotherapy, luspatercept, bone marrow transplantation, stem cell transplantation.Only English language publications from 2012 to December 2020 were included in the literature search. Additional searches using subsection heading terms were conducted by members of the writing committee at the time of final submission to the British Journal of Haematology. Titles and/or abstracts of publications obtained from the database searches described were curated and manually reviewed by members of the writing committee.