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Myelodysplastic syndrome is primarily a disease of older age, and hematopoietic cell transplantation is the only treatment modality that offers the potential of cure and long-term survival to a substantial proportion of patients. Transplantation is used with increasing frequency in older patients, and patients in the seventh or even eighth decade of life have been transplanted successfully. However, transplant outcome strongly depends on the disease characteristics and comorbid conditions, which tend to be common in older individuals and profoundly affect nonrelapse mortality. This is a major reason why in patients older than 60 years, typically only conditioning regimens of reduced intensity are used. However, although these regimens are associated with little acute toxicity, the probability of relapse tends to be higher than with high-intensity regimens. In addition, chronic graft-versus-host disease occurs in as many as 50% to 60% of patients. Manifestations are mild in a proportion of patients; others require long-term treatment, generally with glucocorticoids, which often are not well tolerated in older individuals. Although considerable progress has been made over the past decade, more work is needed, particularly to reduce the incidence of severe graft-versus-host disease and prevent posttransplant relapse.

The National Comprehensive Cancer Network (NCCN) convened a multidisciplinary task force to critically review the evidence for iron chelation and the rationale for treatment of transfusional iron overload in patients with myelodysplastic syndromes (MDS). The task force was charged with addressing issues related to tissue iron toxicity; the role of MRI in assessing iron overload; the rationale and role of treating transfusional iron overload in patients with MDS; and the impact of iron overload on bone marrow transplantation. This report summarizes the background data and ensuing discussion from the NCCN Task Force meeting on transfusional iron overload in MDS.

The myelodysplastic syndromes (MDS) represent a heterogeneous group of clonal hematopoietic disorders characterized by cytopenias, dysplasia in one or more myeloid lineages, and the potential for development of acute myeloid leukemia. These disorders primarily affect older adults. The NCCN Clinical Practice Guidelines in Oncology for MDS provide recommendations on the diagnostic evaluation and classification of MDS, risk evaluation according to established prognostic assessment tools (including the new revised International Prognostic Scoring System), treatment options according to risk categories, and management of related anemia.

The myelodysplastic syndromes (MDS) comprise a heterogenous group of myeloid disorders with a highly variable disease course. Diagnostic criteria to better stratify patients with MDS continue to evolve, based on morphology, cytogenetics, and the presence of cytopenias. More accurate classification of patients will allow for better treatment guidance. Treatment encompasses supportive care, treatment of anemia, low-intensity therapy, and high-intensity therapy. This portion of the guidelines focuses on diagnostic classification, molecular abnormalities, therapeutic options, and recommended treatment approaches.

The NCCN Guidelines for Myelodysplastic Syndromes (MDS) comprise a heterogeneous group of myeloid disorders with a highly variable disease course that depends largely on risk factors. Risk evaluation is therefore a critical component of decision-making in the treatment of MDS. The development of newer treatments and the refinement of current treatment modalities are designed to improve patient outcomes and reduce side effects. These NCCN Guidelines Insights focus on the recent updates to the guidelines, which include the incorporation of a revised prognostic scoring system, addition of molecular abnormalities associated with MDS, and refinement of treatment options involving a discussion of cost of care.