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In LR\u2010MDS, treatment mainly aims at improving cytopenias, principally anaemia, while in HR\u2010MDS it aims at delaying disease progression and prolonging survival. In LR\u2010MDS without deletion 5q, anaemia is generally treated first by erythropoietic stimulating factors, while second line treatments are currently not approved [lenalidomide, hypomethylating agents (HMA), luspatercept] or rarely indicated (antithymocyte globulin). Lenalidomide has major efficacy in LR\u2010MDS with deletion 5q. Allogeneic stem cell transplantation (allo\u2010SCT) is sometimes considered in LR\u2010MDS, and iron chelation can be considered when multiple red blood cell transfusions are required. Allo\u2010SCT is the only potentially curative treatment for HR\u2010MDS; however, it is rarely applicable. It is generally preceded by intensive chemotherapy (IC) or HMA in patients with excess of marrow blasts (especially if &gt;10%). In other patients, HMA can improve survival. The role of new drugs, including venetoclax or, in case of specific mutations, IDH1 or IDH2 inhibitors, is investigated. IC is mainly indicated as a bridge to allo\u2010SCT, in the absence of unfavourable karyotype.<\/jats:p>","DOI":"10.1111\/bjh.16206","type":"journal-article","created":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T05:19:54Z","timestamp":1569907194000},"page":"1016-1027","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":81,"title":["How we manage adults with myelodysplastic syndrome"],"prefix":"10.1111","volume":"189","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0468-3553","authenticated-orcid":false,"given":"Pierre","family":"Fenaux","sequence":"first","affiliation":[{"name":"service d'h\u00e9matologie s\u00e9niors h\u00f4pital St Louis, assistance publique \u2013 h\u00f4pitaux de Paris (APHP) and Universit\u00e9 de Paris Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Platzbecker","sequence":"additional","affiliation":[{"name":"Medical Clinic and Polyclinic 1 Haematology 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