This protocol addresses myelodysplastic syndrome classified as higher-risk (IPSS-R 4.0 or above) occurring in patients with very frail status — a distinct clinical population whose management is shaped by both disease severity and patient frailty.

Clinical scenario

Higher-risk MDS encompasses patients with an IPSS-R of 4.0 or above, including those in the high- and very high-risk categories, as well as remaining intermediate-risk IPSS-R patients in this range. When this risk profile coincides with very frail status, therapeutic decision-making is guided by the patient’s overall condition and tolerance.

Treatment approach (partial overview)

The approach in this setting is centred on supportive care. This includes transfusion support and antimicrobial coverage as appropriate — with particular attention to the haemoglobin level at which transfusions are given, which may vary depending on individual patient tolerance and the presence of other conditions. The complete protocol specifies the full criteria, thresholds, sequencing, and clinical decision pathway.

Treatment goals

The primary aim is to maintain haemoglobin at an adequate level, with the target threshold adjusted upward in patients with comorbidities or poor functional tolerance.

References

DOI: 10.1016/j.annonc.2020.11.002

‘Higher-risk’ MDS includes patients with IPSS-R 4.0, i.e. high- and very high-risk, and the remaining intermediate-risk IPSS-R patients.
Very frail patients
Supportive care: RBC transfusions [IV, A], antibiotics, etc
In patients requiring repeated RBC transfusions, administration at a sufficiently high haemoglobin threshold is recommended (i.e. at least 8 g/dl, and 9 g/dl or even 10 g/dl in cases of comorbidities or poor functional tolerance).

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Treatment of Higher-Risk MDS (IPSS-R ≥ 4.0) in Very Frail Patients

References