This is a 2026 update review covering diagnosis, risk-stratification, and management of myelodysplastic syndromes (MDS/myelodysplastic neoplasms), including the 2022 WHO classification, prognostic scoring systems (IPSS-R, IPSS-M), and available therapies across risk groups.
AlloSCT remains the only curative option. Approved US therapies now include luspatercept (2020), oral decitabine/cedazuridine (2020), and imetelstat (2024) for transfusion-dependent lower-risk MDS. No combination regimen has proven superior to single-agent azacitidine, and no approved options exist for HMA-refractory disease.
As a narrative review/update, it does not present new primary trial data or meta-analytic pooling. Evidence quality for individual recommendations varies and is not formally graded within the abstract.
Risk-stratify all MDS patients using IPSS-R and IPSS-M to guide therapy selection, including transplant eligibility. For transfusion-dependent lower-risk MDS, imetelstat (approved 2024) is now an option alongside luspatercept; no approved therapy exists for HMA-refractory disease, so clinical trial enrollment should be prioritized.
