A precision approach to the treatment of patients with MDS-del(5q). Patients with lower-risk MDS-del(5q) have a median overall survival of ∼5 years, whereas those with higher-risk MDS-del(5q) have a median overall survival of only 2 years. The use of lenalidomide in a patient with a monoallelic TP53 mutation should be carefully discussed with the patient, given the risk of progression to a t-MN. The flowchart does not include patients with MDS with TP53 multihit state; these individuals have TP53-mutant MDS, not MDS-del(5q), as illustrated in Figure 4. Older adult patients with comorbidities and/or frailty may benefit from best supportive care alone, which would represent the initial therapeutic decision, regardless of the IPSS-M. ESAs, erythropoiesis stimulating agents; RBC, red blood cell.
Figure 5.

A precision approach to the treatment of patients with MDS-del(5q). Patients with lower-risk MDS-del(5q) have a median overall survival of ∼5 years, whereas those with higher-risk MDS-del(5q) have a median overall survival of only 2 years. The use of lenalidomide in a patient with a monoallelic TP53 mutation should be carefully discussed with the patient, given the risk of progression to a t-MN. The flowchart does not include patients with MDS with TP53 multihit state; these individuals have TP53-mutant MDS, not MDS-del(5q), as illustrated in Figure 4. Older adult patients with comorbidities and/or frailty may benefit from best supportive care alone, which would represent the initial therapeutic decision, regardless of the IPSS-M. ESAs, erythropoiesis stimulating agents; RBC, red blood cell.

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