Therapy for Myelodysplastic Syndromes Beyond the Front Line in 2024 in Canada


  • Rena Buckstein, MD, FRCPC Odette Cancer Center, Sunnybrook Health Sciences Dept of Medicine University of Toronto Head, Hematology Clinical Trials Chair, MDS-CAN



Management of anemia and/or transfusion dependence (TD) after failure of erythropoietic-stimulating agents (ESA) and therapeutic options after hypomethylating agent (HMA) failures remain the biggest challenges for physicians treating lower and higher-risk myelodysplastic syndromes (MDS), respectively. Fortunately, new therapies are available (or soon to be approved), and innovations in prognostic refinement using next-generation sequencing may also facilitate more precision medicine. This review highlights commercially available (or soon to be) options for the amelioration of anemia and transfusion dependence when ESA’s fail and the management of higher-risk MDS when hypomethylating agents fail or cease working. While not all of these agents are currently funded or approved in Canada, some are available for off-label access or purchase. 

Author Biography

Rena Buckstein, MD, FRCPC, Odette Cancer Center, Sunnybrook Health Sciences Dept of Medicine University of Toronto Head, Hematology Clinical Trials Chair, MDS-CAN

Rena Buckstein is a clinician investigator at the Odette Cancer Centre, Sunnybrook Health Sciences who specializes in malignant hematology. She is an associate professor in the department of medicine at University of Toronto. She completed her medical school training at Boston University and Internal Medicine/Hematology specialty and subspecialty training in Toronto, followed by a fellowship in lymphoma and high dose therapy at Sunnybrook Hospital. She also completed a diploma in clinical epidemiology. She chaired the hematology site group for 15 years and currently leads the hematology clinical trials program at the Odette Cancer Center. Dr. Buckstein founded and chairs a national registry for myelodysplastic syndromes (MDS-CAN) of more than 1400 patients and is an affiliate scientist of Sunnybrook Research Institute. She is a member of the International MDS Foundation scientific advisory board, the Canadian Cancer Society hematology clinical trials sub-committee, a co-chair of an international MDS Guidelines panel for MDS-RIGHT and has chaired national clinical trials in lymphoma and MDS. She has authored and co-authored 144 publications and holds peer reviewed grants from Canadian Cancer Society Research Institute (CCSRI), Canadian Institute of Health Research (CIHR), Ontario Institute for Cancer Research (OICR), and the Leukemia Lymphoma Society of Canada (LLSC) that fund investigator-initiated research in MDS and lymphoma. She is a recipient of the LLSC/UFCW award for leukemia research in Canada. She enjoys teaching and mentoring undergraduate and graduate students. Her interventional research focuses on novel targeted biologic and immunologic therapies for hematologic malignancies focusing on myelodysplastic syndromes and acute myelogenous leukemia and improving the transfusion experience for MDS patients. Her non-interventional research focuses on documenting QOL longitudinally and its predictors and the impact of patient-related factors like frailty and disability on quality of life, and clinical outcomes independent of disease-related prognostic factors. She collaborates on health services research pertaining to ‘real-life’ experience of approved therapies in MDS and the cost/predictors of health care resource utilization. Currently, she is evaluating the impact of age-related clonal hematopoiesis (ARCH) on chemotherapy outcomes in older adults with lymphoid cancers, the association of specific mutations with occult coronary artery disease in MDS patients. 


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How to Cite

Buckstein R. Therapy for Myelodysplastic Syndromes Beyond the Front Line in 2024 in Canada. Can Hematol Today [Internet]. 2024 Jun. 27 [cited 2024 Jul. 23];3(2):22–29. Available from: