In patients with lower risk MDS, anaemia is the most common cytopenia. Erythropoiesis-stimulating agents may be used as first-line therapy.

Available treatment options include (Stojkov et al. 2020; Volpe & Komoroji 2021):

• lenalidomide – specifically approved for patients with transfusion-dependent lower risk MDS with del(5q) abnormality in their karyotype analysis
• hypomethylating agents (HMAs) including azacitidine in patients who progress to higher risk MDS
• immunosuppressive therapy to provide some haematological response among selected subsets of patients.

Timeframe for starting treatment

The timeframe for starting treatment should be guided by clinical presentation and urgency.

Training and experience required of the physician

Documented evidence of the physician’s training and experience (e.g. Fellow of the Royal Australian College of Physicians or equivalent) with adequate training and experience that enables institutional credentialing and agreed scope of practice in haematology.

Health service characteristics

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

• critical care support
• 24-hour medical staff availability
• 24-hour high dependence or intensive care unit
• diagnostic imaging
• pathology diagnostics
• ready access to blood banking and transfusion