Life Expectancy in Myelodysplastic Syndromes: Understanding Prognosis and Factors That Influence Survival

Myelodysplastic syndromes (MDS) are a diverse group of hematologic disorders characterized by ineffective blood cell production and an increased risk of transformation into acute myeloid leukemia (AML). Due to the significant heterogeneity in MDS subtypes and clinical presentations, patient outcomes can vary widely. One of the most reliable tools for predicting survival is the International Prognostic Scoring System (IPSS), which evaluates three key factors: bone marrow blast percentage, cytogenetic abnormalities, and the number of cytopenias.

Prognostic Categories Based on IPSS

Patients classified in the lower-risk categories typically have fewer blasts in the bone marrow (less than 5%), normal or favorable chromosomal patterns, and milder blood count deficiencies. These individuals often experience a more indolent disease course, with median survival ranging from 3 to 5 years. Many remain stable for extended periods and may only require supportive care such as periodic blood transfusions or growth factor therapy.

In contrast, those diagnosed in higher-risk IPSS groups face a more aggressive form of MDS. These patients usually present with higher blast counts (exceeding 10%), complex chromosomal abnormalities, and multiple severe cytopenias. Their disease progresses more rapidly, and without intensive intervention, median survival drops significantly—often between just 0.5 to 1.5 years. For this group, treatment strategies may include hypomethylating agents or even allogeneic stem cell transplantation, which offers the only potential cure but carries substantial risks.

The Role of Age and Comorbidities

MDS predominantly affects older adults, with the majority of cases occurring in individuals over the age of 60. This demographic often presents with additional health challenges beyond MDS, including cardiovascular diseases, diabetes, chronic lung conditions, and other age-related illnesses. As a result, the primary cause of mortality may not be MDS itself, but rather complications from these coexisting conditions.

Tailoring Treatment for Elderly Patients

Given their frailty and reduced physiological reserve, many elderly patients are not candidates for intensive chemotherapy or aggressive interventions. Instead, the focus shifts toward palliative and quality-of-life-centered care. Regular red blood cell and platelet transfusions help manage symptoms of anemia and bleeding risks, while medications like erythropoiesis-stimulating agents can reduce transfusion dependence in some cases.

Supportive therapies also aim to strengthen immune function, prevent infections, and maintain overall well-being. Close monitoring allows clinicians to detect disease progression early and adjust management plans accordingly. In selected fit older adults, newer treatments such as lenalidomide (especially in del(5q) subtype) or hypomethylating drugs like azacitidine and decitabine may offer meaningful benefits.

Looking Ahead: Advances in MDS Management

Ongoing research continues to improve our understanding of MDS biology, leading to better risk stratification and personalized treatment approaches. Emerging biomarkers, targeted therapies, and immunotherapies hold promise for extending survival and enhancing patient outcomes across all risk groups. With comprehensive, individualized care, many people living with MDS today can enjoy longer, more comfortable lives—even when a cure remains out of reach.