Patient selection for ICT

• Consider ICT in transfusion-dependent MDS patients with:
  • SF >1000ng/mL, consistently elevated to ensure IOL, preferably with a fasting TS >50% to exclude with occult blood loss, or with evidence of organ damage from IOL, and:
  • Expected ongoing transfusion requirement with actual or predicted transfusion approaching >20U of PRBC, the number of units depending on transfusion rate. For higher transfusion rate, intervening at a lower number of units is reasonable, while for lower transfusion rate, intervening at a higher number of units may still allow IOL reduction.
  • Life expectancy >1-2 years (low risk [IPSS score of low or int-1, IPSS-R ≤4.5, or WHO classification of MDS-SLD/MDS-RS-SLD/del(5q)MDS] or candidates for SCT.
• Consider ICT in TD MDS patients with a higher IPSS (int-2 or high) or IPSS-R score (>4.5) and:
  • SF >1000ng/mL and life expectancy >1-2 years (candidates for allogeneic SCT, possibly some candidates for or responders to potentially disease modifying therapies).