Bloody Minded Episode 82 - MDS 102 | Much More on Myelodysplastic Syndrome
Mar 17, 2026
Deep dive into classification, risk stratification and treatments for myelodysplastic syndromes. Discussion of key genetic subtypes like del(5q), SF3B1 and biallelic TP53 and their clinical patterns. Coverage of diagnostic pitfalls, flow tools and germline predispositions. Practical treatment topics include lenalidomide, azacitidine, oral decitabine/cedazuridine, luspatercept and transplantation options.
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Look For Germline Syndromes In Young Patients
- Suspect germline predisposition when MDS occurs <50 years, with family history of marrow failure or syndromic findings.
- Test for genes like DDX41, GATA2, SAMD9/SAMD9L and avoid using affected relatives as donors without evaluation.
WHO‑5 Emphasizes Genetic Over Morphology
- WHO‑5 groups MDS into defined genetic entities (del5q, SF3B1, biallelic TP53) and morphologic categories (low blasts, increased blasts, hypoplastic).
- Blast cutoffs for 'low' are <5% marrow/<2% blood; 'increased' grades define worse prognosis.
Count Blasts By Morphology Not Flow For Diagnosis
- Use morphology for blast counts when diagnosing MDS; aspirate and trephine counts matter and flow should not replace morphology for diagnosis.
- Be aware new EHA/ELN guidance recommends flow for AML response assessment only.