MDS Clearpath: An internet-based educational algorithm for the work-up, diagnosis and management of patients with myelodysplastic syndromes from the Canadian Consortium on MDS

2023 update

Authors

  • Heather A. Leitch, MD, PhD St. Paul’s Hospital; University of British Columbia, Vancouver, BC
  • Brian Leber, MD Juravinski Cancer Centre, Hamilton, ON
  • Harold J. Olney, MD Centre Hospitalier de l’Université de Montréal, Montreal, QC
  • April Shamy, MDCM Sir Mortimer B. Davis Jewish General Hospital; McGill University, Montreal, QC

DOI:

https://doi.org/10.58931/cht.2023.2S1137

Abstract

Background

Myelodysplastic Syndrome (MDS) treatments reduce transfusion dependence, delay progression to acute leukemia, and may improve survival. The Canadian Consortium on MDS (CCMDS) developed the MDS ClearPath, a comprehensive tool for the diagnosis, work-up and management of MDS of any risk category at any point during a patient’s disease course.

Methods

The draft ClearPath algorithm was revised by 60 Canadian hematologists, finalized by consensus of the Steering Committee and went live in 2013. The update went online in January 2023.

Results

An approach to the diagnosis and management of MDS is provided. Appropriate investigations are detailed, current scoring systems are included as is a prognostic calculator, and an IPSS-M calculator link is included.

Treatments (erythropoiesis-stimulating agents; lenalidomide; hypomethylating agents; immunosuppressive therapy; supportive care [transfusions; antibiotics; bleeding prevention; iron chelation]; investigational agents; links to clinical trial websites) are detailed, including dosing/administration; monitoring; dose adjustments; expected response; side effect management; and provincial reimbursement.

Added were details on luspatercept, decitabine and decitabine/cedazuridine; recommendations for mutation analysis; WHO and ICC 2022 classifications; the IPSS-M and Clinical Frailty scores; familial predisposition testing; and response assessment criteria. Recommendations are made where data are lacking.

The Treatment Wizard, a series of questions specific to clinical status, leads to treatment recommendations; the self-directed mode is the overall algorithm. References with abstract links are included, and information panels included throughout.

The ClearPath in English or French is available at www.MDSClearPath.org; a (free) iPad app is being updated.

Discussion

The CCMDS presents an internet/app-based algorithm to support MDS management, with recommendations designed to assist in the standardization of MDS care.

Author Biographies

Heather A. Leitch, MD, PhD, St. Paul’s Hospital; University of British Columbia, Vancouver, BC

Dr. Heather Leitch is a Hematologist at St. Paul’s Hospital in Vancouver, Canada and Clinical Professor in the Department of Medicine at the University of British Columbia. Dr. Leitch has a clinical and research interest in transfusional iron overload in acquired anemias such as the myelodysplastic syndromes (MDS), and a longstanding interest in lymphoproliferative and other blood disorders in the setting of HIV infection. She is Director of Hematology/Oncology Research at St. Paul’s Hospital, a reviewer of scientific papers for several medical journals, and an active member of the Canadian Consortium on MDS (CCMDS) and the UBC Department of Medicine Research Advisory Committee.

Brian Leber, MD, Juravinski Cancer Centre, Hamilton, ON

Dr. Brian Leber is a Professor of Medicine (Hematology) at McMaster University and an Attending Hematologist at the Juravinski Hosptial and Cancer Centre of Hamilton Health Sciences. He has a long‑standing interest in myeloid malignancies.

Harold J. Olney, MD, Centre Hospitalier de l’Université de Montréal, Montreal, QC

Dr. Harold Olney is the Chief of the Department of Hematology-Transfusion Medicine and the Director of the malignant cytogenetics laboratory at Centre Hospitalier de l’Université de Montréal (CHUM). He is an Assistant Clinical Professor in the Department of Medicine at the University of Montreal. Dr. Olney’s research Interests include myeloid diseases, lymphoproliferative syndrome, adrenal neoplasia, and Immune thrombocytopenia (ITP).

April Shamy, MDCM, Sir Mortimer B. Davis Jewish General Hospital; McGill University, Montreal, QC

Dr. April Shamy is an Associate Professor of Medicine at McGill University and a member of the Department of Medicine and Department of Oncology at the Jewish General Hospital. Dr. Shamy is a graduate of McGill University Medical School. She completed her Internal Medicine Residency and Hematology Fellowship at McGill University before training in Malignant Hematology at the University of Texas MD Anderson Cancer Centre. She manages a large clinical practice of patients with hematologic cancers and is actively involved in clinical research. She is an active member of the Canadian Consortium on Myelodysplastic Syndromes (CCMDS) and the Groupe des Maladies Plasmocytaires du Quebec (GMPQ). Dr. Shamy is the Medical Director of the Hematology‑Oncology‑Internal Medicine Ward at the JGH and is very involved in teaching within the McGill Medical School Curriculum and in the Internal Medicine and Hematology Residency Programs.

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2023-11-21

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1.
Leitch HA, Leber B, Olney HJ, Shamy A. MDS Clearpath: An internet-based educational algorithm for the work-up, diagnosis and management of patients with myelodysplastic syndromes from the Canadian Consortium on MDS: 2023 update. Can Hematol Today [Internet]. 2023 Nov. 21 [cited 2024 Jul. 27];2(S11):2–14. Available from: https://canadianhematologytoday.com/article/view/2-s11-leitch_et_al

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