Abstract
Background: Low-risk myelodysplastic syndromes (MDS) are heterogeneous hematologic disorders often presenting with anemia and fatigue in older adults with comorbidities. Optimal management requires comprehensive diagnostic evaluation and multidisciplinary care. Real-world practice often reveals variability in testing, treatment initiation, and monitoring. To identify existing gaps in care and potential opportunities for improvement, the Association of Cancer Care Centers worked with 3 cancer centers in Minnesota, Michigan, and Rhode Island on a quality improvement (QI) project focused on low-risk MDS.
Methods: Sites retrospectively reviewed records of patients with low-risk MDS actively receiving treatment. Data points included:
Symptoms documented at the time of diagnosis
Cytogenetic testing and molecular testing rates,
Serum erythropoietin (EPO) level checked prior to receiving an erythropoiesis-stimulating agent (ESA)
Ferritin monitoring in transfusion-dependent patients.
Sites reviewed these findings in a multidisciplinary QI workshop and identified targeted interventions.
Results: Baseline data included 56 patients diagnosed with low-risk MDS and actively receiving treatment. The data revealed the following:
46.4% reported symptoms at the time of diagnosis; 37.5% had no symptoms; 16.1% had no clear documentation about symptoms.
84.2% received cytogenetic testing at diagnosis. 50% received molecular testing at diagnosis.
Among 30 patients treated with ESAs for anemia, 66.7% had a baseline serum EPO.
Among 19 patients who were transfusion-dependent, 84.2% had a recent ferritin level.
12.5% were treated with lenalidomide. 17.9% were treated with luspatercept.
QI interventions recommended standardizing diagnostic workflows to include molecular testing for all patients diagnosed with MDS, updating treatment plans to ensure baseline erythropoietin (EPO) levels are ordered prior to initiating ESA therapy, implementing audit and feedback processes to identify patients who may require ESA dose adjustments or are not responding to therapy, and assessing patients for iron overload to support timely chelation therapy discussions.
Conclusions: Baseline data from this multicenter QI initiative reveals variability in key diagnostic and treatment-related processes for low-risk MDS, with gaps noted in molecular testing, ESA workup, and iron overload monitoring. These findings highlight actionable targets for standardizing care and aligning with best practices. While post-intervention outcomes are pending, these results may guide other centers in identifying and addressing similar gaps to advance patient-centered care in low-risk MDS.
