SOHO 2024 | Challenges in risk stratifying LR-MDS: insights into genetic upstaging and early transplant

I think what we’ve learned, you know, we have the molecular IPSS and actually a couple of other models that definitely can upstage a significant proportion of patients. So I think we have a much better tool for personalizing the prognostic discussion of both the survival and risk of transformation to leukemia. I think the big question is how is it impacting practice? I think the one really major paper recently published by JCO, this is led by the Della Porta group, we’re a part of as well, is looking at earlier transplant in patients that are molecularly upstaged. Actually, a very complex methodological paper. There’s actually a separate paper that associates with it. But essentially, patients that become molecularly higher-risk do benefit from earlier transplant based on the analysis. I do think a prospective randomized trial to support that run by the transplant groups would be great. But I think this is really the key consideration. If you are molecularly upstaged, thinking about earlier transplant. I think how we build that into clinical trials are big questions. Maybe the major benefit right now is if you really want a therapy only for lower-risk (MDS) patients, excluding people that are molecularly high-risk may be a key thing to do in those studies.