Integrating care for patients with lower risk myelodysplastic syndrome.

Patients with lower risk myelodysplastic syndrome (MDS) are those with low or intermediate-1 (INT-1) risk disease by the International Prognostic Scoring System (IPSS) index. Traditionally this has been a subset of patients where the philosophy of therapy has focused on improving transfusion needs. This is the result of the perception that the natural course of patients with lower risk disease is benign and the correct assumption that forms of therapy associated with early induction mortality cannot be justified. Over the last 5 years, we have witnessed significant improvements in our understanding of the natural history and therapy of patients with lower risk MDS. That said, it is not clear that any of these approaches improves survival. In this chapter, I will try to integrate information provided in other articles presented in this issue of Seminars in Oncology with new information regarding the heterogeneity of the natural history of patients with lower risk MDS and propose a framework for future research initiatives for this group of patients.