Treatment patterns and overall survival among patients with myelodysplastic syndromes treated in the US community oncology setting: a real-world retrospective observational study

This retrospective study analyzed EHR data from 2,736 adult MDS patients (IPSS-R risk >1.5), newly diagnosed between January 2011 and January 2021, evaluating characteristics, treatment patterns, and outcomes across IPSS-R categories within the US community oncology setting. Overall, 61.7% initiated 1 L treatment, with higher initiation in higher-risk (IPSS-<i>R</i> > 3) versus low-risk (IPSS-<i>R</i> ≤ 3) patients (74.2% vs. 35.5%). Monotherapy HMA predominated as 1 L therapy, used by 93.4% overall and 95.2% of higher-risk patients. Most discontinued 1 L, with few advancing to 2 L, indicating limited options beyond conventional treatments. Median OS was 22.5 versus 67.2 months for higher- versus low-risk patients, underscoring IPSS-R's prognostic value and poor survival in higher-risk profiles. Allogenic hematopoietic stem cell transplant utilization was low (∼10%) among a subset of higher-risk patients, reflecting eligibility and donor availability constraints. This study highlights real-world MDS treatment patterns and outcomes, emphasizing the need for novel therapies, especially for higher-risk MDS.