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ASH 2025 | Key debates in MDS at ASH 2025: diagnosis, pre-disease therapy, & more
Valeria Santini, MD, University of Florence, Florence, Italy, discusses the key
debates in myelodysplastic syndromes (MDS) that were discussed at ASH 2025. These include the diagnosis of MDS and the potential shift from morphology to molecular characterization, as well as the use of pre-disease therapy in patients with germline predisposition to MDS. This interview took place at the 67th ASH Annual Meeting and Exposition, held in Orlando, FL.
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Transcript
We had a very good discussion and confrontation during the Momentum Symposium of MDS Foundation. We actually discussed several hot topics in the management of MDS, both high-risk and low-risk. One debate was regarding the diagnosis, and I’m starting from it because I think that a good diagnosis can provide an optimal therapy. Diagnosis of MDS is complex, is based nowadays on morphology still, but the debate was exactly focusing on whether morphology should still be the standard of diagnosis or whether we can shift to molecular characterization of MDS...
We had a very good discussion and confrontation during the Momentum Symposium of MDS Foundation. We actually discussed several hot topics in the management of MDS, both high-risk and low-risk. One debate was regarding the diagnosis, and I’m starting from it because I think that a good diagnosis can provide an optimal therapy. Diagnosis of MDS is complex, is based nowadays on morphology still, but the debate was exactly focusing on whether morphology should still be the standard of diagnosis or whether we can shift to molecular characterization of MDS. Now, of course, the debate is open and hot and lively because we still do not have all the MDS classifiable by NGS, by presence of somatic mutation. But that was quite interesting, as well as the second debate. The second debate was even more specialized, in a way, because it was discussing whether all patients with germline predisposition to MDS who saw an assessment that is not routinely performed yet should undergo pre-disease therapy, so prophylactic therapy. And this is something really for the future because we do not have the data on all patients, and of course, depending on the kind of germline predisposition that is present in a substantial proportion of cases, when studied routinely, should be performed. And especially, we should be very careful in when and how we propose stem cell transplant. So, these were the two debates. And then we had a discussion. I actually had the presentation regarding the failures in high-risk MDS clinical trials. Unfortunately, in the last years, we did not succeed in finding a combination of azacitidine and other drugs that could improve survival in high-risk MDS. So, what are the most promising drugs in high-risk MDS? I don’t know, because I think we’re still stuck with azacitidine or decitabine as the main treatment and the standard treatment. I hope that we can find, in the future, a better-designed study that will clarify what we can do to improve our patients’ survival and lives.
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