Managing patients with higher-risk myelodysplastic syndrome with stable disease on hypomethylating agents

Patients with higher-risk MDS have an abysmal survival record and should be started immediately on therapy, the most common of which being the hypomethylating agents, azacitidine or decitabine. Patients achieving a complete or partial response or hematologic improvement have been shown in two separate studies to have an improved overall survival compared to no response. Patients with stable disease at 4-6 months of therapy have an improved survival compared to those with disease progression and a 20% likelihood of an improved subsequent response. These patients can be continued on therapy or considered for clinical trials.