MDS is a heterogeneous group of myeloid clonal disorders of hematopoietic stem cell origin, characterized by abnormal differentiation and development of myeloid cells, manifested by ineffective hematopoiesis, refractory hematocrit, hematopoietic failure, and a high risk of transformation to acute myeloid leukemia (AML).MDS treatment addresses two major issues: bone marrow failure and complications, and AML transformation. As far as the patient population is concerned, the natural course and prognosis of MDS patients are highly variable, and individualization of treatment is desirable. MDS treatment addresses two major issues: bone marrow failure and complications, and AML transformation. In terms of patient populations, the natural course and prognosis of MDS patients are highly variable, and treatment should be individualized. Treatment options are selected based on the prognostic score of MDS patients, along with a comprehensive assessment of the patient’s age, physical status, and adherence. Treatment of MDS in the low-risk group includes component blood transfusion, hematopoietic factor therapy, immunomodulators, and epigenetic drug therapy. Chemotherapy and hematopoietic stem cell transplantation are generally not recommended for patients in the low-risk group, but patients in the younger low-risk group can tolerate high-intensity therapy, which is expected to produce better outcome/risk ratios and progression-free and overall survival rates. MDS in the high-risk group has a poorer prognosis, is prone to conversion to AML, and requires high-intensity therapy, including chemotherapy and HSCT. High-intensity therapy has high treatment-related complications and mortality and is not appropriate for all patients. Supportive therapy includes blood transfusions, erythropoietin (Epo), granulocyte colony-stimulating factor (G-CSF) or granulocyte-macrophage colony-stimulating factor (GM-CSF). It is used for most high-grade MDS and low-risk MDS. The main purpose of supportive therapy is to improve MDS symptoms, prevent infection bleeding and improve quality of life. 1. Blood transfusion In addition to anemia caused by MDS’s own disease, a variety of other factors can aggravate anemia, such as malnutrition, bleeding, hemolysis and infections. In improving anemia, all these factors should be addressed. Red blood cell transfusion is usually given when Hb<60g/L, or when there are obvious anemia symptoms. Old age, limited compensatory response capacity, and increased oxygen demand may relax transfusion without Hb<60g/L. 2. De-iron therapy Iron overload in patients receiving transfusion therapy, especially red blood cell transfusion-dependent MDS, can lead to shorter overall survival if not treated or treated improperly. Serum ferritin (SF) measurement to evaluate iron overload can indirectly reflect the body's iron load, but SF levels fluctuate widely and are easily affected by infection, inflammation, tumor, liver disease and alcohol abuse. For patients dependent on red blood cell infusion, SF should be monitored 3 to 4 times a year. patients receiving iron chelation therapy should have their iron load monitored according to the guidelines for the use of the selected drug, and the function of the involved organs should be evaluated regularly. Iron chelation therapy (ICT) can reduce SF levels and iron levels in the liver and heart, and is effective depending on the duration of drug administration, dose, patient tolerance, and concurrent transfusion. Iron removal therapy can also be terminated if iron removal therapy is no longer the patient's point of maximum benefit. Commonly used drugs are: Desferrioxamine, Deferiprone, Deferasirox. Platelet transfusion The recommended infusion point is 20×10^9/L for patients with risk factors for platelet depletion (infection, bleeding, use of antibiotics or anti-human thymocyte immunoglobulin, etc.) and 10×10^9/L for stable patients. 4. Neutrophil-promoting therapy Patients with neutrophil deficiency may be given G-CSF/GM-CSF to achieve neutrophils >1×10^9/L. Antibiotic prophylaxis for infection is not recommended for MDS. 5. Erythropoietic therapy Epo is the main initial treatment for low-risk MDS, transfusion-dependent patients, and the addition of G-CSF can increase the erythropoietic response for 6 weeks. For non-responders, Epo can be applied in additional doses and treatment can be continued for 6 weeks. For those who respond to treatment, once maximum efficacy is achieved, the application of G-CSF and Epo is gradually reduced until the original efficacy is maintained with the smallest dose.