[Management of MDS according to risk classifications]

Myelodysplastic syndromes (MDS) are clonal hematopoietic neoplasms caused by genetic abnormalities in hematopoietic stem cells and exhibit a heterogeneous clinical course. In the 2022 WHO classification (5th edition), the term was revised to "myelodysplastic neoplasms," reflecting their neoplastic nature, and both disease classification and prognostic stratification now incorporate genetic mutations. Diagnostic evaluation includes bone marrow examination with biopsy, iron staining, cytogenetic analysis, and comprehensive gene panel testing. Treatment strategies are determined based on risk stratification by the Revised International Prognostic Scoring System (IPSS-R) and the molecular IPSS (IPSS-M). In lower-risk MDS, supportive care remains the mainstay, with erythropoiesis-stimulating agents (ESAs), luspatercept, and lenalidomide as therapeutic options. In higher-risk cases, allogeneic hematopoietic stem cell transplantation remains the only curative therapy for eligible patients, while azacitidine is used for transplant-ineligible patients. As genomic profiling becomes more integrated into clinical practice, treatment selection based on specific genetic alterations is advancing, and further development of personalized therapy is anticipated.