Guidelines for Myelodysplastic Syndromes: Converting Evidence into Action?

Abstract

The heterogeneous group of myelodysplastic syndromes (MDS) needs an individualized and patient-tailored therapeutic approach. Consensus-based guidelines for diagnosis and treatment provide a basis for clinical decision making. MDS guidelines are issued by expert panels. Our main objective was to examine how guidelines influence patients’ adherence to expert recommendations and how they ensure healthcare quality. To approach this question, we reviewed the most common guidelines for diagnosing and treating MDS in adult patients. Furthermore, we critically looked at quality indicators for everyday practice and studied adherence in an everyday outpatient setting. Finally, we also paid close attention to patient-reported outcome measures and studied how they are used as endpoints in clinical trials. We can conclude that the combination of evidence-based diagnostic tools, standardized treatment recommendations, and patient-centered shared decision making will eventually lead to a healthcare standard that will significantly improve outcomes in adult patients with MDS.

Management of infection prophylaxis in Dutch patients with myelodysplastic syndromes, a web‐based case vignette questionnaire: The MINDSET study

“…Guidelines or recommendations may lead haematologists in their consideration, however, to the best of our knowledge, guidelines specifically focussing on the prevention of infections in MDS are lacking. 7,[15][16][17][18][19][20][21]28,30 This is the first nationwide study to describe the perception of haematologists in the Netherlands with respect to the prescription of infection prophylaxis in patients with MDS. The availability of protocols for the prevention of infections in MDS patients were investigated, along with the empiricism in infection prevention in MDS, which can aid in transforming literature into practice.…”

“…The initiation of infection prophylaxis is preferably determined through patient‐based risk factors and the preference of the haematologist, and some decisions regarding anti‐infective prophylaxis may involve infectious‐disease specialists. Guidelines or recommendations may lead haematologists in their consideration, however, to the best of our knowledge, guidelines specifically focussing on the prevention of infections in MDS are lacking 7,15–21,28,30 …”

Treatment of myeloid neoplasia with doxorubicin and cytarabine in 11 dogs

“…While there is neither a treatment consensus nor a guideline for canine MDS, survival times of 7–138 days were reported with glucocorticoid and/or immunosuppressive therapy, 5,6,9,19 and survival of more than 1 year with cytarabine and prednisone therapy 8,10 . In humans, MDS is an extremely heterogeneous neoplasm with disease progression that ranges from slow to moderate based on genetic risk factors, severity of cytopenia, proportion of blasts and co‐morbidities 39,40 . Treatment of human patients is tailored according to individual risk factors, and can range from monitoring without therapy to systemic chemotherapy and/or allogeneic stem cell transplantation 39 .…”

“…8,10 In humans, MDS is an extremely heterogeneous neoplasm with disease progression that ranges from slow to moderate based on genetic risk factors, severity of cytopenia, proportion of blasts and co-morbidities. 39,40 Treatment of human patients is tailored according to individual risk factors, and can range from monitoring without therapy to systemic chemotherapy and/or allogeneic stem cell transplantation. 39 Given the rarity of the disease in dogs, a multi-institutional study of a large number of cases with clinical follow-up will be required to better characterize the natural history of the disease and response to therapy.…”

“…39,40 Treatment of human patients is tailored according to individual risk factors, and can range from monitoring without therapy to systemic chemotherapy and/or allogeneic stem cell transplantation. 39 Given the rarity of the disease in dogs, a multi-institutional study of a large number of cases with clinical follow-up will be required to better characterize the natural history of the disease and response to therapy. pected to be related to doxorubicin toxicity.…”