Analysis shows marked difference in treatment patterns, survival between MDS risk groups

Treatment strategies and survival outcomes substantially differed between patients with low-risk versus high-risk myelodysplastic syndromes (MDS), according to an analysis of the Spanish Registry of Myelodysplastic Syndromes (RESMD), a prospective national MDS registry. The study, led by Raúl Azibeiro Melchor, of Hospital Universitario de Salamanca in Spain, was presented at the Fourteenth Annual Meeting of the Society of Hematologic Oncology in Houston, Texas.

The RESMD dataset included 20,755 patients (60.1% male) with a median age of 74 years. Based on World Health Organization 2017 classifications, 32.2% of patients had MDS with multilineage or single-lineage dysplasia, 17.2% had MDS with ring sideroblasts, 12.9% had MDS with excess blasts-1, 12.6% had MDS with excess blasts-2, 15.1% had chronic myelomonocytic leukemia, and 4.4% had MDS with deletion of chromosome 5q. Out of 14,398 patients with available risk classifications, 61.9% of patients were stratified as low or very low risk based on Revised International Prognostic Scoring System (IPSS-R) criteria.

The survival analysis included 13,546 patients with available follow-up. The median overall survival (OS) was 69.6 months for low-risk patients (IPSS-R ≤3.5) compared with 17.2 months for high-risk patients (IPSS-R >3.5), and 5-year OS was 55.4% compared with 18.8%, respectively. Nonleukemic mortality due to infections, comorbidities or hemorrhage was the most common cause of death in low-risk patients (77.2%), while progression to acute myeloid leukemia was the most common for high-risk patients (37.1%). Erythropoiesis-stimulating agents were the most common first-line treatment for low-risk patients (62%), while azacitidine or other hypomethylating agent was the most common for high-risk patients (46.1%).

“The divergence in survival, mortality causes, and treatment strategies across risk groups underscores the importance of risk-adapted management and highlights distinct unmet needs in both low- and high-risk disease,” Melchor and colleagues wrote.

Read more from SOHO 2026 here.