Higher-Risk MDS (IPSS-R ≥4.0) in Patients Aged ≤70 Without an Available Stem Cell Donor
This protocol covers the management of higher-risk myelodysplastic syndrome in patients aged 70 years or younger who have no unfavourable karyotype and no available donor for allogeneic stem cell transplantation.
Clinical Scenario
Higher-risk MDS encompasses patients with an IPSS-R score of 4.0 or above — covering high- and very high-risk, as well as remaining intermediate-risk IPSS-R patients. This protocol applies specifically to those aged 70 years or younger, with no unfavourable karyotype, and no donor available for allogeneic stem cell transplantation.
Treatment Approach
For this patient population, the approach centres on access to clinical trials evaluating investigational agents — a strategy supported by evidence-based recommendations in this setting.
Specific eligibility criteria, agent selection, and the full structured protocol are available via the complete regimen →
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.
- Patients of 70 years and no unfavourable karyotype
- Patients of >70 years or younger but without a donor for allo-SCT
- IPSS higher-risk MDS patients who fail to respond to HMAs have a very poor survival (median <6 months) unless they are potentially eligible for allo-SCT.
- The recommended approach is to enrol these patients into a clinical trial with investigational agents [IV, B].
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