MDS 2023 | Optimizing therapy for patients with high-risk MDS

Optimization of therapy for patients with high risk MDS is a slow-going process. We have made some advances and I think it was a nice introduction session yesterday where we really went over where are we now in MDS, especially in high-risk MDS. We have improvements in supportive care and we have improvements in allogeneic transplant and those are modalities that can help us improve the life and quality and quantity of life of our higher risk patients. We really have not made a significant change in our chemotherapy. I think that where I see the field going is trying to look more at different phases of treatment and optimize each phase of treatment. Maybe we need to focus on smaller portions of disease. So maybe we need more trials looking specifically on how can we improve the response rate initially to treatment. The quality of that response, the time to response, the number of people who get a good response. Second, I think we need to then separately think about how to consolidate that response and so for people who are undergoing transplant, that’s again one area where we’ve made advances, getting more people to transplant and thinking about how to optimize transplant as well, avoiding relapse, remain areas of need. But if you’re not going to transplant, do you need to stay on the same intensity of therapy after remission? Can we deescalate or provide things that allow for maintenance of a better quality of life after getting a response? Then even further long term, can we maintain a response longer because we really still have very few tools for relapse and progression? How do we maintain a response for a longer period? So I think looking at these little parts of treatment, I hope is the way that we move forward. But we still have a lot of work to do.