NCCN Guidelines® Insights: Myelodysplastic Syndromes, Version 2.2025

Featured Updates to the NCCN Guidelines

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Peter L. Greenberg Stanford Cancer Institute

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Richard M. Stone Dana-Farber/Brigham and Women’s Cancer Center

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Yasmin Abaza Robert H. Lurie Comprehensive Cancer Center of Northwestern University

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Aref Al-Kali Mayo Clinic Comprehensive Cancer Center

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Sarah Anand University of Michigan Rogel Cancer Center

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Brian Ball City of Hope National Medical Center

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John M. Bennett University of Rochester

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Uma Borate The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute

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Andrew M. Brunner Mass General Cancer Center

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Wanxing Chai-Ho UCLA Jonsson Comprehensive Cancer Center

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Peter Curtin City of Hope National Medical Center

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Amy E. DeZern Johns Hopkins Kimmel Cancer Center

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Karin Gaensler UCSF Helen Diller Family Comprehensive Cancer Center

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Zhubin Gahvari University of Wisconsin Carbone Cancer Center

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Guillermo Garcia-Manero The University of Texas MD Anderson Cancer Center

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Elizabeth A. Griffiths Roswell Park Comprehensive Cancer Center

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Tamanna Haque Memorial Sloan Kettering Cancer Center

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Meagan Jacoby Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

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Brian A. Jonas UC Davis Comprehensive Cancer Center

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Sioban Keel Fred Hutchinson Cancer Center

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Rashmi Khanal Fox Chase Cancer Center

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Ashwin Kishtagari Vanderbilt-Ingram Cancer Center

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Yazan Madanat UT Southwestern Simmons Comprehensive Cancer Center

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Lori J. Maness Fred & Pamela Buffett Cancer Center

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Shannon R. McCurdy Abramson Cancer Center at the University of Pennsylvania

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Christine McMahon University of Colorado Cancer Center

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Olatoyosi Odenike The UChicago Medicine Comprehensive Cancer Center

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Afaf Osman Huntsman Cancer Institute at the University of Utah

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Vishnu V. Reddy O’Neal Comprehensive Cancer Center at UAB

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David A. Sallman Moffitt Cancer Center

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Hamid Sayar Indiana University Melvin and Bren Simon Comprehensive Cancer Center

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Rory Shallis Yale Cancer Center/Smilow Cancer Hospital

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Abhay Singh Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute

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Tiffany Tanaka UC San Diego Moores Cancer Center

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Swapna Thota St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center

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Emily Kovach National Comprehensive Cancer Network

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Jamie Nguyen National Comprehensive Cancer Network

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Cindy Hochstetler National Comprehensive Cancer Network

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The NCCN Guidelines for Myelodysplastic Syndromes (MDS) provide recommendations for the evaluation, diagnosis, and comprehensive care of patients with MDS based on a review of recent clinical evidence that has led to important advances in treatment or has yielded new information on biologic factors that may have prognostic significance in MDS. The multidisciplinary panel of MDS experts is convened at least on an annual basis. During the annual meeting, the panel evaluates new and emerging data to inform their recommendations. These NCCN Guidelines Insights review the recent updates, including treatment recommendations both for lower-risk and higher-risk MDS, preference stratification of therapeutic agents, and emerging data on novel therapeutics.

Provided content development and/or authorship assistance

Peter L. Greenberg, Emily Kovach, Jamie Nguyen, and Cindy Hochstetler

The full and most current version of these NCCN Guidelines is available at NCCN.org.

NCCN CATEGORIES OF EVIDENCE AND CONSENSUS

Category 1: Based upon high-level evidence (≥1 randomized phase 3 trials or high-quality, robust meta-analyses), there is uniform NCCN consensus (≥85% support of the Panel) that the intervention is appropriate.

Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus (≥85% support of the Panel) that the intervention is appropriate.

Category 2B: Based upon lower-level evidence, there is NCCN consensus (≥50%, but <85% support of the Panel) that the intervention is appropriate.

Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate.

All recommendations are category 2A unless otherwise indicated.

NCCN CATEGORIES OF PREFERENCE

Preferred intervention: Interventions that are based on superior efficacy, safety, and evidence; and, when appropriate, affordability.

Other recommended intervention: Other interventions that may be somewhat less efficacious, more toxic, or based on less mature data; or significantly less affordable for similar outcomes.

Useful in certain circumstances: Other interventions that may be used for selected patient populations (defined with recommendation).

All recommendations are considered appropriate.

NCCN recognizes the importance of clinical trials and encourages participation when applicable and available. Trials should be designed to maximize inclusiveness and broad representative enrollment.

PLEASE NOTE

The NCCN Guidelines® are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment.

The NCCN Guidelines® Insights highlight important changes in the NCCN Guidelines® recommendations from previous versions. Colored markings in the algorithm show changes and the discussion aims to further understanding of these changes by summarizing salient portions of the panel’s discussion, including the literature reviewed.

The NCCN Guidelines Insights do not represent the full NCCN Guidelines; further, the National Comprehensive Cancer Network® (NCCN®) makes no representations or warranties of any kind regarding the content, use, or application of the NCCN Guidelines and NCCN Guidelines Insights and disclaims any responsibility for their application or use in any way.

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