WPSS (WHO classification-based Prognostic Scoring System) for Myelodysplastic Syndrome

• Management should be guided by clinician expertise, the patient’s overall clinical scenario, and individual preferences.
• MDS can evolve; frequent re-evaluation is recommended if clinical status changes or new data become available.

Low- or very low-risk: 

• Asymptomatic patients may be appropriate for monitoring and supportive measures (e.g., transfusions).
• Low-intensity therapies (e.g., growth factors, hypomethylating agents, luspatercept, lenalidomide, immunosuppressives, and targeted agents) may be considered if symptomatic.
• More intensive therapy can be offered to younger, fit patients based on clinical circumstances and pathologic features.

High- or very high-risk:

• Therapy choice often depends on the patient’s medical fitness and pathologic features. Options can include:
  • Low-intensity therapies listed above (e.g., hypomethylating agents, targeted therapies).
  • High-intensity therapies, such as chemotherapy with or without allogeneic hematopoietic cell transplantation (HCT).