Myelodysplastic neoplasms (MDS) are a group of acquired clonal hematopoietic stem cell disorders characterized by peripheral cytopenias and a risk of leukemic transformation. A narrative review published in the Annales Africaines de Médecine aims to synthesize recent data on the classification, diagnosis, prognosis, and management of MDS, with a particular focus on the African context. The review, authored by Amine Benmoussa, Nizar Dahmaoui, and others, was published in the September 2026 issue of the journal.
The diagnosis of MDS relies on the association of cytopenia, bone marrow dysplasia, and/or an increase in blasts, confirmed by cytogenetics and molecular biology. The World Health Organization (WHO) 2022 classification and the molecular prognostic score Molecular International Prognostic Scoring System (IPSS-M) have recently transformed management. The IPSS-M integrates mutations in 16 genes to refine prognostic stratification compared to IPSS-R.
In low-risk MDS, treatment aims to correct anemia using erythropoiesis-stimulating agents, lenalidomide in MDS with del(5q), and luspatercept. For high-risk MDS, azacitidine and allogeneic hematopoietic stem cell transplantation (HSCT) remain the therapeutic cornerstones, although combinations such as venetoclax + azacitidine are under evaluation.
Major challenges in managing MDS include treatment resistance, comorbidity management, and limited access to innovative therapies, essential drugs like azacitidine, and transplant platforms, particularly in Africa. The management of MDS has evolved toward precision medicine, integrating molecular data for prognosis and therapeutic decision-making.
Allogeneic HSCT remains the only curative treatment for eligible high-risk patients. Efforts are needed to improve access to molecular diagnostics and therapies in Africa. The review highlights the need for increased awareness and education on MDS, as well as the importance of developing context-specific guidelines for diagnosis and treatment.
The review was based on a literature search of 53 articles published between January 2010 and December 2024, critically analyzed to develop a qualitative narrative synthesis. The authors emphasize the importance of continued research and collaboration to address the challenges in managing MDS in Africa and to improve patient outcomes.
Key points
- Limited access to diagnostic tools and innovative therapies hinders the effective management of myelodysplastic neoplasms in Africa.
- The integration of molecular data into prognosis and therapeutic decision-making is transforming the management of MDS.
- Allogeneic hematopoietic stem cell transplantation remains the only curative treatment for eligible high-risk MDS patients.
