Supportive therapies are required in all MDS patients and may be the only long-term treatment required for those with lower risk disease, or for older or unfit patients and those who have not responded to other treatments (Fenaux et al. 2021).

Supportive therapy may include the following:

• Conduct regular blood tests and review appointments with the patient’s general practitioner and specialist to monitor progress and symptoms.
• Manage anaemia, including red blood cell transfusions – frequency will be determined by symptoms and comorbidities.
• Manage bleeding, which may include platelet transfusions or tranexamic acid when
• Manage infections – prompt antibiotics for infection and consideration of short-term use of growth factors (e.g. GCSF). Infectious disease consultation may be required if infections recur. Anti-fungal prophylaxis may be considered in patients with persistent severe neutropenia depending on local guidelines and practice.
• Consider iron chelation therapy for transfusional iron overload. In general, this is considered for patients with significant transfusion burden and evidence for iron overload. Both oral and

Parenteral chelation therapy options are available and could be tailored to the patient depending on clinical need.

• Manage gastrointestinal symptoms such as nausea, vomiting, loss of appetite, dysgeusia, diarrhoea or constipation as a result of treatment. This requires optimal symptom control with medicine, nutritional advice, analgesia and mouth care (referral to a dietitian may be required if dietary intake is affected).

Timeframe for starting treatment

The timeframe for starting treatment should be guided by clinical presentation and urgency and disease progression over time.

Training and experience required of the physician

Documented evidence of the physician’s training and experience, including their specific (sub-specialty) experience with MDS and procedures to be undertaken, should be available.

Health service characteristics

To provide safe and quality care for patients, health services should have these features:

• medical staff availability
• diagnostic imaging