1.What kind of disease is MDS? Myelodysplastic syndrome, which is often referred to as MDS, is classified as a malignant blood disorder. Although many patients show a persistent decrease in blood cells in the early stages, which can last for several years, and the malignant cells in the bone marrow, i.e., the primitive cells, never increase, in total, about one-third of patients develop acute leukemia. Therefore, the disease has a tendency to become malignant. MDS was once called pre-leukemia, but now, because of the in-depth understanding of its pathogenesis, it is internationally unified as myelodysplastic syndrome, which is an independent disease. 2.What are the clinical manifestations of MDS? MDS is often seen in patients over 50 years of age, and its incidence rises gradually with age, with the incidence in older people over 70 years of age even exceeding that of acute leukemia. In recent years, it is not uncommon for patients under the age of 50 to develop MDS, which often manifests clinically as a persistent reduction in one or more lines of blood cells, with anemia being the most common, hence the name refractory anemia in the past. There is also concurrent leukocytopenia and thrombocytopenia. Because of chronic low blood cells, this can lead to recurrent infections, bleeding, and anemia symptoms. Long-term anemia may also lead to anemic heart disease. 3.Diagnosis of MDS? MDS can be diagnosed through modern technology, such as morphology of hematopoietic cells in the bone marrow, immunology, and molecular biology. The differential diagnosis of MDS is particularly important because many systemic diseases, nutritional status, and medications may produce MDS-like pathological hematopoiesis. At present, the academic community mainly refers to the Vienna MDS diagnostic criteria. 4. Why is prognostic assessment of MDS necessary? In order to evaluate the prognosis of patients and propose strategies for treatment, clinicians mainly use scoring systems to evaluate, and there are two major scoring systems, IPSS and WPSS, which are based on a large number of patient data and summarized through evidence-based medicine, and represent most of the clinical evolution of MDS and can be used as clinical reference. However, because of the large individual differences in MDS patients, there are also those that do not conform to the pattern. Through evaluation, we roughly divide MDS into a low-risk group and a high-risk group, and the prognosis and treatment of the two groups are absolutely different. 5.What are the treatment options for MDS? The treatment strategies for the low-risk group and the high-risk group are different. Treatment for patients with MDS in the low-risk group includes component blood transfusions, hematopoietic factor therapy, immunomodulators, and epigenetic drugs. Chemotherapy and hematopoietic stem cell transplantation are generally not recommended for patients in the low-risk group. Patients with MDS in the high-risk group have a poor prognosis, are prone to conversion to AML, and require high-intensity therapy, including chemotherapy and hematopoietic stem cell transplantation. High-intensity therapy has a high rate of treatment-related complications and morbidity and mortality and is not suitable for all patients. In general, treatment is individualized based on the patient’s specific situation, age, physical condition, type of diagnosis, prognostic grouping, and individual wishes.