{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T13:17:27Z","timestamp":1783430247772,"version":"3.54.6"},"reference-count":87,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Andrea Brumwell, PhD of MEDUCOM Health Inc."},{"name":"Taiho Pharma Canada, Inc., Oakville, ON, Canada"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Hypomethylating agents (HMAs) are the cornerstone in the treatment of higher-risk myelodysplastic syndromes (MDSs), particularly for patients who are not candidates for allogeneic hematopoietic cell transplant (allo-HCT). Despite demonstrated efficacy in improving hematologic outcomes, the clinical management of HMA-associated myelosuppression remains a challenge. This review discusses the use of azacitidine and oral decitabine-cedazuridine (DEC-C) for MDS management in the Canadian context, with a focus on optimizing therapy to mitigate myelosuppression and prevent early HMA discontinuation due to toxicity. Close monitoring of complete blood counts is critical to early detection of myelosuppression and management of treatment-related cytopenias. In the real-world setting, specific HMA dose adjustments are used based on patient risk factors for myelosuppression or treatment-related complications. Supportive care strategies, including the use of growth factors and antimicrobials, can complement monitoring and dose modifications for HMA-related myelosuppression management, although their use is variable. This review summarizes current evidence and real-world management approaches for HMA-induced myelosuppression, with the aim of improving outcomes for patients undergoing treatment for MDS.<\/jats:p>","DOI":"10.3390\/curroncol33070404","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T09:53:46Z","timestamp":1783418026000},"page":"404","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-World Management of HMA-Related Myelosuppression During MDS Treatment in the Canadian Landscape"],"prefix":"10.3390","volume":"33","author":[{"given":"Michelle","family":"Geddes","sequence":"first","affiliation":[{"name":"Division of Hematology and Hematologic Malignancies, Arthur J.E. Child Comprehensive Cancer Centre, Calgary, AB T2N 5G2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8776-4083","authenticated-orcid":false,"given":"Brett L.","family":"Houston","sequence":"additional","affiliation":[{"name":"Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada"},{"name":"CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lalit","family":"Saini","sequence":"additional","affiliation":[{"name":"London Health Sciences Centre, London, ON N6A 5W9, Canada"},{"name":"Department of Medicine, The University of Western Ontario, London, ON N6A 3K7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismail","family":"Sharif","sequence":"additional","affiliation":[{"name":"Peterborough Regional Health Centre, Peterborough, ON K9J 7C6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rena","family":"Buckstein","sequence":"additional","affiliation":[{"name":"Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan J.","family":"Stubbins","sequence":"additional","affiliation":[{"name":"Leukemia\/BMT Program of British Columbia, Vancouver Coastal Health, BC Cancer, Vancouver, BC V5Z 1M9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"ref_1","first-page":"339","article-title":"Treatment of high-risk myelodysplastic syndromes","volume":"110","year":"2025","journal-title":"Haematologica"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/S1470-2045(09)70003-8","article-title":"Efficacy of azacitidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: A randomised, open-label, phase III study","volume":"10","author":"Fenaux","year":"2009","journal-title":"Lancet Oncol."},{"key":"ref_3","unstructured":"Bristol-Myers Squibb Canada (2026, June 29). 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