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MDS occurs more frequently in older male and in individuals with prior exposure to cytotoxic therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Diagnosis:<\/jats:title><jats:p>Diagnosis of MDS is based on morphological evidence of dysplasia upon visual examination of a bone marrow aspirate and biopsy. Information obtained from additional studies such as karyotype, flow cytometry, or molecular genetics is complementary but not diagnostic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Risk\u2010stratification:<\/jats:title><jats:p>Prognosis of patients with MDS can be calculated using a number of scoring systems. In general, all these scoring systems include analysis of peripheral cytopenias, percentage of blasts in the bone marrow, and cytogenetic characteristics. The most commonly used system is the International Prognostic Scoring System. This score divides patients into a lower risk subset (low and intermediate\u20101) and a higher risk subset (int\u20102 and high). Other more modern systems have been developed that allow more precise risk calculation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Risk\u2010adapted therapy:<\/jats:title><jats:p>Therapy is selected based on risk, transfusion needs, percent of bone marrow blasts and more recently cytogenetic profile. Goals of therapy are different in lower risk patients than in higher risk. In lower risk, the goal is to decrease transfusion needs and transformation to higher risk disease or AML. In higher risk, the goal is to prolong survival. Current available therapies include growth factor support, lenalidomide, hypomethylating agents, intensive chemotherapy, and allogeneic stem cell transplantation. The use of lenalidomide has significant clinical activity in patients with lower risk disease, anemia, and a chromosome 5 alteration. 5\u2010azacitidine and decitabine have activity in higher risk MDS. 5\u2010azacitidine has been shown to improve survival in higher risk MDS. Additional supportive care measures may include the use of prophylactic antibiotics and iron chelation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Management of progressive or refractory disease:<\/jats:title><jats:p>At the present time, there are no approved interventions for patients with progressive or refractory disease particularly after hypomethylating based therapy. Options include cytarabine\u2010based therapy, transplantation, and participation on a clinical trial. Am. J. Hematol. 86:491\u2013498, 2011. \u00a9 2011 Wiley\u2010Liss, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ajh.22047","type":"journal-article","created":{"date-parts":[[2011,5,18]],"date-time":"2011-05-18T13:55:31Z","timestamp":1305726931000},"page":"490-498","source":"Crossref","is-referenced-by-count":42,"title":["Myelodysplastic syndromes: 2011 update on diagnosis, risk\u2010stratification, and 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