title: Current state of prognostication and risk stratification in myelodysplastic syndromes.
abstract: OBJECTIVE
  Myelodysplastic syndromes (MDS) are characterized by significant biologic and clinical heterogeneity. Because of the wide outcome variability, accurate prognostication is vital to high-quality risk-adaptive care of MDS patients. In this review, we discuss the current state of prognostic schemes for MDS and overview efforts aimed at utilizing molecular aberrations for prognostication in clinical practice.
  
  
  RESULTS
  Several prognostic instruments have been developed and validated with increasing accuracy and complexity. Oncologists should be aware of the inherent limitations of these prognostic tools as they counsel patients and make clinical decisions. As more therapies are becoming available for MDS, the focus of model development is shifting from prognostic to treatment-specific predictive instruments. In addition to providing additional prognostic data beyond traditional clinical and pathologic parameters, the improved understanding of the genetic landscape and pathophysiologic consequences in MDS may allow the construction of treatment-specific predictive instruments.
  
  
  CONCLUSIONS
  How to best use the results of molecular mutation testing to inform clinical decision making in MDS is still a work in progress. Important steps in this direction include standardization in performance and interpretation of assays and better understanding of the independent prognostic importance of the recurrent mutations, especially the less frequent ones.
authors.affiliation: aSection of Hematology, Department of Internal Medicine, Yale University, New Haven, Connecticut bDepartment of Malignant Hematology, H Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.
authors.forename: Amer M
authors.initials: AM
authors.lastname: Zeidan
authors.forename: Steven D
authors.initials: SD
authors.lastname: Gore
authors.forename: Eric
authors.initials: E
authors.lastname: Padron
authors.forename: Rami S
authors.initials: RS
authors.lastname: Komrokji
mesh_terms: D002869:Chromosome Aberrations; D015897:Comorbidity; D018450:Disease Progression; D023281:Genomics / Q000379:methods; D006801:Humans; D009154:Mutation; D009190:Myelodysplastic Syndromes / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D012306:Risk