Review

. 2023 Nov:62:101128.

doi: 10.1016/j.blre.2023.101128. Epub 2023 Aug 19.

Classification, risk stratification and response assessment in myelodysplastic syndromes/neoplasms (MDS): A state-of-the-art report on behalf of the International Consortium for MDS (icMDS)

Maximilian Stahl¹, Jan Philipp Bewersdorf², Zhuoer Xie³, Matteo Giovanni Della Porta⁴, Rami Komrokji³, Mina L Xu⁵, Omar Abdel-Wahab², Justin Taylor⁶, David P Steensma⁷, Daniel T Starczynowski⁸, Mikkael A Sekeres⁶, Guillermo Sanz⁹, David A Sallman³, Gail J Roboz¹⁰, Uwe Platzbecker¹¹, Mrinal M Patnaik¹², Eric Padron³, Olatoyosi Odenike¹³, Stephen D Nimer⁶, Aziz Nazha¹⁴, Ravi Majeti¹⁵, Sanam Loghavi¹⁶, Richard F Little¹⁷, Alan F List¹⁸, Tae Kon Kim¹⁹, Christopher S Hourigan²⁰, Robert P Hasserjian²¹, Stephanie Halene²², Elizabeth A Griffiths²³, Steven D Gore¹⁷, Peter Greenberg²⁴, Maria E Figueroa⁶, Pierre Fenaux²⁵, Fabio Efficace²⁶, Amy E DeZern²⁷, Naval G Daver²⁸, Jane E Churpek²⁹, Hetty E Carraway³⁰, Rena Buckstein³¹, Andrew M Brunner³², Jacqueline Boultwood³³, Uma Borate³⁴, Rafael Bejar³⁵, John M Bennett³⁶, Andrew H Wei³⁷, Valeria Santini³⁸, Michael R Savona¹⁹, Amer M Zeidan³⁹

Affiliations

¹ Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
² Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
³ Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
⁴ IRCCS Humanitas Clinical and Research Center & Humanitas University, Department of Biomedical Sciences, via Manzoni 56, 20089, Rozzano, Milan, Italy.
⁵ Departments of Pathology & Laboratory Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA.
⁶ Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
⁷ David Steensma LLC, Cambridge, Massachusetts 02139, USA.
⁸ Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
⁹ Health Research Institute La Fe, Valencia, Spain; Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBERONC, IS Carlos III, Madrid, Spain.
¹⁰ Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY, USA.
¹¹ Leipzig University Hospital, Leipzig, Germany.
¹² Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
¹³ Leukemia Program, University of Chicago Medicine and University of Chicago Comprehensive Cancer Center, Chicago, IL, USA.
¹⁴ Department of Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
¹⁵ Division of Hematology, Department of Medicine, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
¹⁶ Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹⁷ National Cancer Institute, Cancer Therapy Evaluation Program, Rockville, MD, USA.
¹⁸ Precision BioSciences, Inc., Durham, NC, USA.
¹⁹ Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
²⁰ Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, and Myeloid Malignancies Program, National Institutes of Health, Bethesda, MD, 20892, USA.
²¹ Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
²² Section of Hematology, Department of Internal Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA.
²³ Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
²⁴ Division of Hematology, Department of Medicine, Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.
²⁵ Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris and Paris Cité University, Paris, France.
²⁶ Italian Group for Adult Hematologic Diseases (GIMEMA), Health Outcomes Research Unit, Rome, Italy.
²⁷ Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA.
²⁸ Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
²⁹ Department of Hematology, Oncology, and Palliative Care, Carbone Cancer Center, The University of Wisconsin-Madison, Madison, WI, USA.
³⁰ Leukemia Program, Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
³¹ Department of Medical Oncology/ Hematology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
³² Leukemia Program, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
³³ Blood Cancer UK Molecular Haematology Unit, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
³⁴ Ohio State University Comprehensive Cancer Center/ James Cancer Hospital, Ohio State University, Columbus, OH, USA.
³⁵ Division of Hematology and Oncology, Moores Cancer Center, UC San Diego, La Jolla, CA, USA.
³⁶ University of Rochester Medical Center, Department of Pathology and Laboratory Medical Center, Rochester, NY, USA.
³⁷ Department of Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Walter and Eliza Hall Institute of Medical Research and University of Melbourne, Victoria, Australia.
³⁸ MDS Unit, Hematology, AOUC, University of Florence, Italy.
³⁹ Section of Hematology, Department of Internal Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA. Electronic address: amer.zeidan@yale.edu.

PMID: 37704469
DOI: 10.1016/j.blre.2023.101128

Review

Classification, risk stratification and response assessment in myelodysplastic syndromes/neoplasms (MDS): A state-of-the-art report on behalf of the International Consortium for MDS (icMDS)

Maximilian Stahl et al. Blood Rev. 2023 Nov.

. 2023 Nov:62:101128.

doi: 10.1016/j.blre.2023.101128. Epub 2023 Aug 19.

Authors

Affiliations

¹ Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
² Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
³ Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
⁴ IRCCS Humanitas Clinical and Research Center & Humanitas University, Department of Biomedical Sciences, via Manzoni 56, 20089, Rozzano, Milan, Italy.
⁵ Departments of Pathology & Laboratory Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA.
⁶ Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
⁷ David Steensma LLC, Cambridge, Massachusetts 02139, USA.
⁸ Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
⁹ Health Research Institute La Fe, Valencia, Spain; Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBERONC, IS Carlos III, Madrid, Spain.
¹⁰ Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY, USA.
¹¹ Leipzig University Hospital, Leipzig, Germany.
¹² Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
¹³ Leukemia Program, University of Chicago Medicine and University of Chicago Comprehensive Cancer Center, Chicago, IL, USA.
¹⁴ Department of Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
¹⁵ Division of Hematology, Department of Medicine, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
¹⁶ Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹⁷ National Cancer Institute, Cancer Therapy Evaluation Program, Rockville, MD, USA.
¹⁸ Precision BioSciences, Inc., Durham, NC, USA.
¹⁹ Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
²⁰ Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, and Myeloid Malignancies Program, National Institutes of Health, Bethesda, MD, 20892, USA.
²¹ Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
²² Section of Hematology, Department of Internal Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA.
²³ Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
²⁴ Division of Hematology, Department of Medicine, Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.
²⁵ Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris and Paris Cité University, Paris, France.
²⁶ Italian Group for Adult Hematologic Diseases (GIMEMA), Health Outcomes Research Unit, Rome, Italy.
²⁷ Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA.
²⁸ Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
²⁹ Department of Hematology, Oncology, and Palliative Care, Carbone Cancer Center, The University of Wisconsin-Madison, Madison, WI, USA.
³⁰ Leukemia Program, Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
³¹ Department of Medical Oncology/ Hematology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
³² Leukemia Program, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
³³ Blood Cancer UK Molecular Haematology Unit, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
³⁴ Ohio State University Comprehensive Cancer Center/ James Cancer Hospital, Ohio State University, Columbus, OH, USA.
³⁵ Division of Hematology and Oncology, Moores Cancer Center, UC San Diego, La Jolla, CA, USA.
³⁶ University of Rochester Medical Center, Department of Pathology and Laboratory Medical Center, Rochester, NY, USA.
³⁷ Department of Haematology, Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Walter and Eliza Hall Institute of Medical Research and University of Melbourne, Victoria, Australia.
³⁸ MDS Unit, Hematology, AOUC, University of Florence, Italy.
³⁹ Section of Hematology, Department of Internal Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA. Electronic address: amer.zeidan@yale.edu.

PMID: 37704469
DOI: 10.1016/j.blre.2023.101128

Abstract

The guidelines for classification, prognostication, and response assessment of myelodysplastic syndromes/neoplasms (MDS) have all recently been updated. In this report on behalf of the International Consortium for MDS (icMDS) we summarize these developments. We first critically examine the updated World Health Organization (WHO) classification and the International Consensus Classification (ICC) of MDS. We then compare traditional and molecularly based risk MDS risk assessment tools. Lastly, we discuss limitations of criteria in measuring therapeutic benefit and highlight how the International Working Group (IWG) 2018 and 2023 response criteria addressed these deficiencies and are endorsed by the icMDS. We also address the importance of patient centered care by discussing the value of quality-of-life assessment. We hope that the reader of this review will have a better understanding of how to classify MDS, predict clinical outcomes and evaluate therapeutic outcomes.

Keywords: Diagnostic criteria; IPSS-M; MDS; Myelodysplastic syndrome; Novel therapies; Risk classification.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest Maximilian Stahl consulted for Curis Oncology and Boston Consulting; served on the advisory board for Novartis and Kymera, GSK, Rigel, Sierra Oncology; and participated in GME activity for Novartis, Curis Oncology, Haymarket Media and Clinical care options (CCO). Elizabeth A. Griffiths has received honoraria for advisory board membership from AbbVie, Alexion Pharmaceuticals, Apellis, Celgene/BMS, CTI Biopharma, Genentech, Novartis, Picnic Health, Takeda Oncology, Taiho Oncology. EAG has received research funding from Astex Pharmaceuticals, AstraZeneca Rare Disease, Alexion Pharmaceuticals, Apellis Pharmaceuticals, Blueprint Medicines, Genentech Inc., and honoraria for CME activities from Physicians Educational Resource, MediComWorldwide, American Society of Hematology, AAMDS International Foundation. Ravindra Majeti is on the Advisory Boards of Kodikaz Therapeutic Solutions, Syros Pharmaceuticals, TenSixteen Bio, Roche, and Cullgen Inc. and is an inventor on several patents related to CD47 cancer immunotherapy licensed to Gilead Sciences. R.M. receives research support from Gilead Sciences. Ravindra Majeti. is a co-founder and equity holder of Pheast Therapeutics, MyeloGene, and Orbital Therapeutics. Stephanie Halene consulted for Forma Therapeutics. Daniel T. Starczynowski is a consultant and received research funding from Kymera Therapeutics, Kurome Therapeutics, Captor Therapeutics, and Tolero Therapeutics. Daniel T. Starczynowski has equity in Kurome Therapeutics. Gail Roboz: Consultancy: Abbvie, Amgen, Argenx, Astra Zeneca, Bluebird Bio, Blueprint Medicines, Bristol-Myers Squibb, Caribou Biosciences, Celgene, Daiichi Sankyo, Ellipses Pharma, GlaxoSmithKline, Janssen, Jasper Pharmaceuticals, Jazz Pharmaceuticals, Molecular Partners, Novartis, Pfizer, Rigel, Roche, Syndax, Takeda (IRC Chair), Telix Pharma Research support: Janssen. David A. Sallman served on the advisory board of Aprea, AvenCell, BlueBird Bio, BMS, Intellia, Kite, Novartis, Shattuck Labs, Servier, Syndax. David A. Sallman served as a consultant for AbbVie, Magenta, Molecular Partners AG, Takeda and on the speakers' bureau for BMS, Incyte, Servier; David A. Sallman received research funding from Aprea, Jazz. Mrinal Patnaik received research funding from Kura Oncology and StemLine Pharmaceuticals. Andrew Brunner received consulting or advisory board honoraria from Novartis, Acceleron, Agios, Abbvie, Takeda, Celgene/BMS, Keros Therapeutics, Taiho, Gilead. Andrew Brunner has research support from the NIH SPORE in Myeloid Malignancies, and from the Edward P. Evans Foundation. Tae Kon Kim received research funding from Nextcure and is a consultant for Agenus. Alan List is employed by and has equity in Precision BioSciences, and has served as a consultant for Halia Therapeutics, CTI Biopharma, Aileron. Naval Daver has received research funding from Daiichi-Sankyo, Bristol-Myers Squibb, Pfizer, Gilead, Sevier, Genentech, Astellas, Daiichi-Sankyo, Abbvie, Hanmi, Trovagene, FATE therapeutics, Amgen, Novimmune, Glycomimetics, Trillium, and ImmunoGen and has served in a consulting or advisory role for Daiichi-Sankyo, Bristol-Myers Squibb, Arog, Pfizer, Novartis, Jazz, Celgene, AbbVie, Astellas, Genentech, Immunogen, Servier, Syndax, Trillium, Gilead, Amgen, Shattuck labs, and Agios. Guillermo Sanz received honoraria, advisory board membership or consultation fees from AbbVie, BMS, ExCellThera, Novartis, Roche, and Takeda and participated in sponsored speaker's bureau for BMS, Novartis, and Takeda. Mikkael A. Sekeres has served on advisory boards for BMS, Novartis, Kurome, and Gilead. Pierre Fenaux received research funding from BMS, Abbvie, Jazz Pharmaceuticals, Novartis, and Janssen. Pierre Fenaux had a consultancy with and received honoraria from BMS, Abbvie, Jazz Pharmaceuticals, and Novartis. Fabio Efficace had a consultancy or advisory role for AbbVie, Incyte, Janssen, and Syros, outside the submitted work. Omar Abdel-Wahab has served as a consultant for H3B Biomedicine, Foundation Medicine Inc., Merck, Prelude Therapeutics, and Janssen, and is on the Scientific Advisory Board of Envisagenics Inc., AIChemy, Harmonic Discovery Inc., and Pfizer Boulder; Omar Abdel-Wahab has received prior research funding from H3B Biomedicine and LOXO Oncology unrelated to the current manuscript. Andrew H.Wei has served on advisory boards for Novartis, Astra Zeneca, Astellas, Janssen, Jazz, Amgen, Roche, Pfizer, Abbvie, Servier, Gilead, BMS, Shoreline, Macrogenics, Novartis and Agios; receives research funding to the Institution from Novartis, Abbvie, Servier, Janssen, BMS, Syndax, Astex, Astra Zeneca, Amgen; serves on speaker's bureaus for Abbvie, Novartis, BMS, Servier, Astellas; Andrew H.Wei is an employee of the Walter and Eliza Hall Institute (WEHI). WEHI receives milestone and royalty payments related to the development of Venetoclax. Current and past employees of Walter and Eliza Hall Institute may be eligible for financial benefits related to these payments. Andrew H. Wei receives such a financial benefit. Amer M. Zeidan received research funding (institutional) from Celgene/BMS, Abbvie, Astex, Pfizer, Medimmune/AstraZeneca, Boehringer-Ingelheim, Cardiff oncology, Incyte, Takeda, Novartis, Aprea, and ADC Therapeutics. AMZ participated in advisory boards, and/or had a consultancy with and received honoraria from AbbVie, Otsuka, Pfizer, Celgene/BMS, Jazz, Incyte, Agios, Boehringer-Ingelheim, Novartis, Acceleron, Astellas, Daiichi Sankyo, Cardinal Health, Taiho, Seattle Genetics, BeyondSpring, Cardiff Oncology, Takeda, Ionis, Amgen, Janssen, Epizyme, Syndax, Gilead, Kura, Chiesi, ALX Oncology, BioCryst, Notable, Orum, and Tyme. AMZ served on clinical trial committees for Novartis, Abbvie, Gilead, BioCryst, Abbvie, ALX Oncology, Geron and Celgene/BMS. The National Heart, Lung, and Blood Institute receives research funding for the laboratory of Dr. Hourigan from Sellas and from the Foundation of the NIH AML MRD Biomarkers Consortium. All other authors have no conflicts of interest to disclose.

Cited by

Latest Insights and Therapeutic Advances in Myelodysplastic Neoplasms.
Niscola P, Gianfelici V, Giovannini M, Piccioni D, Mazzone C, de Fabritiis P. Niscola P, et al. Cancers (Basel). 2024 Apr 19;16(8):1563. doi: 10.3390/cancers16081563. Cancers (Basel). 2024. PMID: 38672645 Free PMC article. Review.
Measurable (Minimal) Residual Disease in Myelodysplastic Neoplasms (MDS): Current State and Perspectives.
Zhang L, Deeb G, Deeb KK, Vale C, Peker Barclift D, Papadantonakis N. Zhang L, et al. Cancers (Basel). 2024 Apr 15;16(8):1503. doi: 10.3390/cancers16081503. Cancers (Basel). 2024. PMID: 38672585 Free PMC article. Review.
Engagement of Mesenchymal Stromal Cells in the Remodeling of the Bone Marrow Microenvironment in Hematological Cancers.
Giallongo S, Duminuco A, Dulcamare I, Zuppelli T, La Spina E, Scandura G, Santisi A, Romano A, Di Raimondo F, Tibullo D, Palumbo GA, Giallongo C. Giallongo S, et al. Biomolecules. 2023 Nov 24;13(12):1701. doi: 10.3390/biom13121701. Biomolecules. 2023. PMID: 38136573 Free PMC article. Review.
Transfusion avoidance in myelodysplastic neoplasms.
Griffiths EA. Griffiths EA. Curr Opin Hematol. 2024 Mar 1;31(2):40-46. doi: 10.1097/MOH.0000000000000794. Epub 2023 Nov 16. Curr Opin Hematol. 2024. PMID: 37982261 Review.

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- Elsevier Science
Medical
- Genetic Alliance
- MedlinePlus Health Information
Research Materials
- NCI CPTC Antibody Characterization Program
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Classification, risk stratification and response assessment in myelodysplastic syndromes/neoplasms (MDS): A state-of-the-art report on behalf of the International Consortium for MDS (icMDS)

Affiliations

Classification, risk stratification and response assessment in myelodysplastic syndromes/neoplasms (MDS): A state-of-the-art report on behalf of the International Consortium for MDS (icMDS)

Authors

Affiliations

Abstract

Conflict of interest statement

Similar articles

Cited by

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous

Abstract

Conflict of interest statement

Similar articles

Cited by

Publication types

MeSH terms

Related information

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous