{"id":5223,"date":"2024-12-11T18:17:08","date_gmt":"2024-12-11T17:17:08","guid":{"rendered":"https:\/\/irccs.com\/patologie\/myelodysplastic-neoplasms\/"},"modified":"2026-06-23T12:16:45","modified_gmt":"2026-06-23T10:16:45","slug":"myelodysplastic-neoplasms","status":"publish","type":"pathology","link":"https:\/\/inoc.it\/en\/pathology\/myelodysplastic-neoplasms\/","title":{"rendered":"Myelodysplastic Neoplasms"},"content":{"rendered":"\n<h3 class=\"wp-block-heading\">Pathology<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Myelodysplastic neoplasms (MDS)<\/strong> are a group of blood disorders in which <strong>bone marrow cells fail to mature properly into functional blood cells<\/strong> or have a shortened lifespan once they enter the circulation.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">MDS are considered <strong>clonal disorders<\/strong>, meaning that the disease originates from a single cell that acquires genetic alterations. This abnormal cell escapes normal regulatory mechanisms and proliferates, producing cells with altered structure and function and passing these abnormalities on to subsequent generations of cells.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">As a result, the production of <strong>red blood cells, white blood cells, and platelets<\/strong> becomes impaired. In some cases, there is also an increase in <strong>blasts<\/strong>, the immature precursors of white blood cells, in the bone marrow or peripheral blood.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Types<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Myelodysplastic neoplasms are classified into several subtypes based on <strong>blood and bone marrow findings<\/strong>. Advances in the understanding of chromosomal abnormalities and genetic mutations led to an updated classification in 2022 by the <strong>World Health Organization (WHO)<\/strong> and the <strong>International Consensus Classification (ICC)<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Current categories include:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Genetically Defined MDS<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">These forms are characterized by specific genetic abnormalities, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>SF3B1 mutation<\/strong><\/li>\n\n\n\n<li><strong>TP53 mutation<\/strong><\/li>\n\n\n\n<li><strong>Deletion of the long arm of chromosome 5 [del(5q)]<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Morphologically Defined MDS<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">These forms are classified according to bone marrow characteristics, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Ring sideroblasts<\/strong> (iron accumulation within red blood cell precursors)<\/li>\n\n\n\n<li><strong>Hypoplastic MDS<\/strong> (reduced bone marrow cellularity)<\/li>\n\n\n\n<li><strong>MDS with bone marrow fibrosis<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>MDS Defined by Blast Percentage<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">These forms are classified according to the proportion of blasts in the bone marrow:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>MDS with blasts &lt;5%<\/strong><\/li>\n\n\n\n<li><strong>MDS with increased blasts-1 (5-9%)<\/strong><\/li>\n\n\n\n<li><strong>MDS with increased blasts-2 (10-19%)<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">This classification helps physicians better understand the biological behavior of the disease and select the most appropriate treatment for each patient.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">The Numbers in Italy<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Myelodysplastic neoplasms are <strong>rare diseases<\/strong>. In Italy, approximately <strong>5,000 new cases<\/strong> are diagnosed each year.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The annual incidence ranges from <strong>2 to 10 cases per 100,000 people<\/strong>, depending on age and sex. MDS is more common in <strong>men<\/strong> and becomes increasingly frequent with advancing age, reaching <strong>15 to 30 cases per 100,000 people<\/strong> among individuals over 70 years of age.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"symptoms\" class=\"h2_anchor\"><\/span>Symptoms<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">TSymptoms and disease course vary considerably according to the type of blood cell affected.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Anemia:<\/strong> A reduction in red blood cells may cause <strong>fatigue, reduced exercise tolerance, rapid heartbeat, and shortness of breath<\/strong>.<strong>Neutropenia:<\/strong> A reduction in neutrophils may lead to <strong>frequent infections<\/strong> and <strong>prolonged or recurrent infectious episodes<\/strong>.<strong>Thrombocytopenia:<\/strong> A reduction in platelets may cause <strong>petechiae, easy bruising (hematomas), and bleeding of the gums or other mucous membranes<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Some patients may have <strong>no symptoms at diagnosis<\/strong>, and the disease may be identified following abnormalities detected during routine blood tests.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"risk-factors\" class=\"h2_anchor\"><\/span>Risk Factors<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">In most cases, the exact cause of myelodysplastic neoplasms remains unknown. These are <strong>not hereditary disorders<\/strong>, although rare familial forms have been described.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">MDS occurs predominantly in <strong>older adults<\/strong>. In some cases, it may develop following exposure to certain substances, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Benzene<\/strong><\/li>\n\n\n\n<li><strong>Lead<\/strong><\/li>\n\n\n\n<li><strong>Industrial solvents<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">MDS may also occur after previous treatment with <strong>chemotherapy<\/strong> or <strong>ionizing radiation<\/strong>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"diagnosis-and-examination\" class=\"h2_anchor\"><\/span>Diagnosis and Examination<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The diagnostic pathway often begins with abnormalities detected on a <strong>complete blood count<\/strong>, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Anemia<\/strong><\/li>\n\n\n\n<li><strong>Neutropenia<\/strong><\/li>\n\n\n\n<li><strong>Thrombocytopenia<\/strong><\/li>\n\n\n\n<li><strong>Macrocytosis<\/strong> (enlarged red blood cells)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">When these abnormalities persist and cannot be explained by other causes, patients should be referred to an <strong>oncohematologist<\/strong> for specialist evaluation and further diagnostic investigations.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">To establish the diagnosis, the specialist will first request <strong>blood tests and bone marrow examinations<\/strong>, which are essential for confirming the disease and defining its characteristics.<\/p>\n\n\n\t<div id=\"block_6a3a5d0b541a6\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Blood Tests  <\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">Most patients with <strong>myelodysplastic neoplasms (MDS)<\/strong> present with abnormalities in their <strong>complete blood count<\/strong>. These may include <strong>anemia, neutropenia, thrombocytopenia<\/strong>, or a combination of two or all three cytopenias.<\/p>\n<p class=\"isSelectedEnd\">Before confirming a diagnosis of MDS, several blood tests are required to exclude other conditions that may cause similar abnormalities:<\/p>\n<ul data-spread=\"false\">\n<li><strong>Reticulocyte count, LDH, and bilirubin levels<\/strong> to exclude <strong>hemolysis<\/strong><\/li>\n<li><strong>Iron studies<\/strong> and assessment of <strong>vitamin B12 and folate levels<\/strong> to identify nutritional deficiencies<\/li>\n<li><strong>Serum erythropoietin measurement<\/strong> and evaluation of <strong>transfusion history<\/strong><\/li>\n<li><strong>Peripheral blood smear<\/strong> for morphological assessment of blood cells<\/li>\n<li><strong>Liver and kidney function tests<\/strong>, <strong>inflammatory markers<\/strong>, <strong>serum protein electrophoresis<\/strong>, and <strong>thyroid function tests<\/strong> to exclude other conditions associated with cytopenias, such as chronic liver disease, kidney failure, inflammatory disorders, or thyroid dysfunction<\/li>\n<li>Screening for <strong>HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), parvovirus B19<\/strong> (particularly in hypoplastic forms), and <strong>cytomegalovirus (CMV)<\/strong><\/li>\n<li><strong>Peripheral blood immunophenotyping<\/strong>, in selected cases, to identify clones associated with <strong>paroxysmal nocturnal hemoglobinuria (PNH)<\/strong><\/li>\n<\/ul>\n<p>These investigations help establish the diagnosis and exclude alternative causes of blood count abnormalities.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Bone Marrow Aspiration and Bone Marrow Biopsy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">diagnosis of <strong>myelodysplastic neoplasms (MDS)<\/strong> requires both a <strong>bone marrow aspiration<\/strong> and a <strong>bone marrow biopsy<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">These procedures are usually performed during the same session under <strong>local anesthesia<\/strong>, typically at the level of the <strong>posterior iliac crest<\/strong> of the pelvis. During the procedure, a sample of <strong>bone marrow blood<\/strong> is aspirated, and a small <strong>bone marrow tissue sample<\/strong> is collected for analysis.<\/p>\n<p class=\"isSelectedEnd\"><strong>Bone Marrow Aspiration<\/strong><\/p>\n<p class=\"isSelectedEnd\">The bone marrow aspirate is used for several investigations:<\/p>\n<ul data-spread=\"true\">\n<li><strong>Morphological examination:<\/strong> a small amount of bone marrow blood is spread onto a slide, stained, and examined under a microscope. Morphological assessment remains a cornerstone of MDS diagnosis and classification. It allows the identification of abnormalities in blood-forming cells and the quantification of <strong>blasts<\/strong>, the immature precursors of blood cells.<\/li>\n<li><strong>Flow cytometry immunophenotyping:<\/strong> used to identify abnormal cell populations, evaluate maturation abnormalities, and quantify blasts.<\/li>\n<li><strong>Cytogenetic analysis:<\/strong> evaluates chromosomal abnormalities through techniques such as <strong>karyotyping<\/strong> and <strong>fluorescence in situ hybridization (FISH)<\/strong>, which can detect specific genetic alterations with diagnostic, prognostic, and therapeutic relevance.<\/li>\n<li><strong>Perls staining:<\/strong> used to identify and quantify <strong>ring sideroblasts<\/strong>, a feature that characterizes specific MDS subtypes and may influence treatment decisions.<\/li>\n<li><strong>Molecular testing:<\/strong> assesses mutations in genes such as <strong>SF3B1, TP53, and IDH1<\/strong>. These analyses contribute to diagnosis, risk stratification, prognosis, and the selection of targeted therapies when appropriate.<\/li>\n<\/ul>\n<p><strong>Bone Marrow Biopsy<\/strong><\/p>\n<p class=\"isSelectedEnd\">The bone marrow biopsy provides tissue for <strong>histological examination<\/strong>, allowing evaluation of:<\/p>\n<ul data-spread=\"false\">\n<li><strong>Bone marrow cellularity<\/strong><\/li>\n<li><strong>Morphological and structural abnormalities<\/strong><\/li>\n<li><strong>Blast percentage<\/strong> through immunohistochemical analysis<\/li>\n<li><strong>Degree of bone marrow fibrosis<\/strong><\/li>\n<\/ul>\n<p><strong>The Importance of Specialized Diagnostic Evaluation<\/strong><\/p>\n<p class=\"isSelectedEnd\">Current international classifications recognize that specific <strong>cytogenetic and molecular abnormalities<\/strong> are often associated with distinct biological and morphological features and have important <strong>diagnostic, prognostic, and therapeutic implications<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">For this reason, comprehensive laboratory evaluation is essential for all patients with newly diagnosed MDS and should be performed in <strong>highly specialized centers<\/strong>.<\/p>\n<p><strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong> offers access to advanced diagnostic technologies, specialized expertise, and collaboration with national reference laboratories to ensure a comprehensive and accurate diagnostic assessment.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Other Examinations<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">The diagnostic workup may be complemented by <strong>laboratory and instrumental investigations<\/strong>, such as <strong>abdominal ultrasound<\/strong> or <strong>echocardiography<\/strong>, to evaluate any existing <strong>comorbidities<\/strong> and the patient&#8217;s overall health status.<\/p>\n<p class=\"isSelectedEnd\">For all patients who may be candidates for active treatment, it is important to assess <strong>general health, performance status, and the presence of other medical conditions<\/strong> in order to determine fitness for therapy and define the most appropriate treatment strategy.<\/p>\n<p class=\"isSelectedEnd\">For patients with reduced functional independence, the availability of <strong>family members or caregivers<\/strong> who can provide support during treatment should also be considered when planning care.<\/p>\n<p>The diagnostic evaluation should allow classification of patients according to the criteria established in 2022 by the <strong>World Health Organization (WHO)<\/strong> and the <strong>International Consensus Classification (ICC)<\/strong>. In addition, prognosis is assessed using internationally validated scoring systems, including the <strong>IPSS, IPSS-R, and IPSS-M<\/strong>, which help guide treatment decisions and risk stratification.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h3 class=\"wp-block-heading\">Prognostic Evaluation<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">At the time of diagnosis, physicians collect a range of <strong>clinical, laboratory, cytogenetic, and molecular data<\/strong> to assess the prognosis of the disease. This information is essential for estimating the risk of progression and selecting the most appropriate treatment strategy for each patient.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The main prognostic scoring systems currently used are <strong>IPSS<\/strong>, <strong>IPSS-R<\/strong>, and <strong>IPSS-M<\/strong>. These tools evaluate several factors, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Cytogenetic abnormalities<\/strong><\/li>\n\n\n\n<li><strong>Number and severity of cytopenias<\/strong><\/li>\n\n\n\n<li><strong>Percentage of blasts in the bone marrow<\/strong><\/li>\n\n\n\n<li><strong>Specific genetic mutations<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Based on these scores, patients are classified into different risk categories, ranging from <strong>lower-risk<\/strong> to <strong>higher-risk disease<\/strong>, according to their likelihood of progression to more aggressive forms of MDS or <strong>acute myeloid leukemia (AML)<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The main goals of treatment for myelodysplastic neoplasms are to:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Improve symptoms<\/strong> by correcting anemia and other cytopenias<\/li>\n\n\n\n<li><strong>Modify the natural course of the disease<\/strong>, with the aim of prolonging survival and reducing the risk of progression<\/li>\n\n\n\n<li><strong>Preserve and improve quality of life<\/strong><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"therapies\" class=\"h2_anchor\"><\/span>Therapies<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">After the diagnosis is confirmed, the specialists within the <strong><a href=\"https:\/\/inoc.it\/en\/pathology\/myelodysplastic-neoplasms\/#multi-disciplinary-team\">Multidisciplinary Team<\/a><\/strong> (<strong>GIC<\/strong>) evaluate multiple factors related to the patient, the characteristics of the disease, symptoms, and associated risks in order to develop an <strong>individualized treatment plan<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The treatment strategy depends on the <strong>subtype and risk category of MDS<\/strong>, as well as the patient&#8217;s <strong>age, overall health, performance status, and comorbidities<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>oncohematologist<\/strong> discusses the proposed treatment plan with the patient, providing information on its goals, duration, administration schedule, and potential side effects. Whenever appropriate, alternative treatment options with comparable efficacy are also presented to support <strong>shared decision-making<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients also receive guidance regarding:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Lifestyle recommendations<\/strong>, including nutrition and daily activities<\/li>\n\n\n\n<li><strong>Communication and care pathways<\/strong> involving physicians, nurses, and other healthcare professionals across different clinical settings, including outpatient clinics, inpatient wards, and the stem cell transplantation unit<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Treatment options for MDS may include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Erythropoiesis-stimulating agents<\/strong>, used to increase red blood cell production<\/li>\n\n\n\n<li><strong>Hypomethylating agents<\/strong><\/li>\n\n\n\n<li><strong>Targeted therapies<\/strong><\/li>\n\n\n\n<li><strong>Chemotherapy<\/strong>, in selected cases<\/li>\n\n\n\n<li><strong>Allogeneic stem cell transplantation<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Currently,<a href=\"https:\/\/inoc.it\/en\/medical-area\/hemopoietic-stem-cell-transplantation-and-cellular-therapies-center\/\"> <strong>allogeneic stem cell transplantation<\/strong> <\/a>is the only treatment with the potential to achieve long-term disease eradication. It may be considered for selected patients with <strong>intermediate-risk or high-risk MDS<\/strong> who are fit enough to undergo the procedure. For this reason, eligible patients should be evaluated early by an <strong>oncohematologist with expertise in cellular therapies<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong> offers a dedicated <strong>Transplant Center<\/strong> with specialized multidisciplinary teams, advanced technologies, and comprehensive expertise in stem cell transplantation, ensuring highly specialized care for patients who may benefit from this approach.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">All newly diagnosed patients with <strong>high-risk disease<\/strong> should also be evaluated for potential participation in <strong>clinical trials<\/strong>. If an experimental treatment is considered appropriate, the option is discussed within the <strong>GIC<\/strong> and presented to the patient as part of a shared decision-making process.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Alongside disease-specific treatments, <strong>supportive care<\/strong> plays a fundamental role in stabilizing the patient&#8217;s clinical condition, reducing disease-related complications, and minimizing treatment-related side effects.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In selected patients with <strong>lower-risk disease<\/strong>, mild symptoms, and stable blood counts, immediate treatment may not be necessary. In these cases, a strategy of <strong>active monitoring<\/strong> may be adopted, with regular blood tests and bone marrow evaluations to track disease progression. Treatment can be initiated if blood counts worsen, symptoms develop, or the number of blasts increases.<\/p>\n\n\n\t<div id=\"block_6a3a5d0b54273\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Treatment of Lower-Risk Patients<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">Most patients with <strong>lower-risk MDS<\/strong> present with <strong>anemia<\/strong>. Treatment is aimed at improving blood counts, reducing transfusion requirements, relieving symptoms, and maintaining quality of life.<\/p>\n<p class=\"isSelectedEnd\"><strong>Erythropoiesis-Stimulating Agents<\/strong><\/p>\n<p>The most commonly used first-line treatment is <strong>recombinant erythropoietin (EPO)<\/strong>.<\/p>\n<p>Erythropoietin is a naturally occurring hormone that stimulates the production of red blood cells. In patients with MDS, red blood cell production may be insufficient, and when endogenous EPO levels are not excessively elevated, a synthetic form can be administered by <strong>subcutaneous injection<\/strong>.<\/p>\n<p>Treatment with recombinant EPO can increase hemoglobin levels or achieve <strong>transfusion independence<\/strong> in approximately <strong>40-50% of patients<\/strong>, while also improving clinical outcomes in responders.<\/p>\n<p class=\"isSelectedEnd\"><strong>Luspatercept<\/strong><\/p>\n<p class=\"isSelectedEnd\">For patients with <strong>MDS with ring sideroblasts<\/strong> or an <strong>SF3B1 mutation<\/strong> who are not suitable candidates for EPO therapy or who do not respond adequately, <strong>luspatercept<\/strong> may be used.<\/p>\n<p class=\"isSelectedEnd\">Luspatercept is a <strong>targeted therapy<\/strong> that promotes red blood cell maturation by modulating the <strong>TGF-\u03b2 signaling pathway<\/strong>. It can improve anemia and reduce transfusion requirements in a substantial proportion of patients. The treatment is administered by <strong>subcutaneous injection every three weeks<\/strong> and is generally continued long term.<\/p>\n<p class=\"isSelectedEnd\">Recent clinical studies have also expanded the potential role of luspatercept in selected patients with <strong>lower-risk MDS requiring transfusions<\/strong>, including some patients without ring sideroblasts or an SF3B1 mutation.<\/p>\n<p class=\"isSelectedEnd\"><strong>Lenalidomide for MDS With del(5q)<\/strong><\/p>\n<p class=\"isSelectedEnd\">Patients with <strong>MDS associated with deletion of chromosome 5q <span class=\"text-token-text-primary cursor-text rounded-sm\" data-placeholder-token=\"true\">[del(5q)]<\/span><\/strong> who are not eligible for or do not respond to EPO therapy may benefit from <strong>lenalidomide<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">Lenalidomide is an <strong>oral targeted therapy<\/strong> that selectively affects cells carrying the del(5q) abnormality. It can achieve <strong>transfusion independence<\/strong> in a large proportion of patients and may improve long-term outcomes.<\/p>\n<p class=\"isSelectedEnd\"><strong>Red Blood Cell Transfusions<\/strong><\/p>\n<p class=\"isSelectedEnd\">When hemoglobin levels become significantly reduced, particularly below <strong>8 g\/dL<\/strong>, or below <strong>10 g\/dL<\/strong> in symptomatic patients or those with underlying cardiovascular disease, <strong>red blood cell transfusions<\/strong> may be required.<\/p>\n<p class=\"isSelectedEnd\">Transfusions can rapidly improve anemia-related symptoms, including fatigue, shortness of breath, and reduced physical capacity.<\/p>\n<p class=\"isSelectedEnd\"><strong>Iron Chelation Therapy<\/strong><\/p>\n<p class=\"isSelectedEnd\">Patients who require repeated red blood cell transfusions over an extended period may develop <strong>iron overload<\/strong>, which can affect organs such as the <strong>heart, liver, and endocrine glands<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">In these cases, <strong>iron chelation therapy<\/strong> may be prescribed to remove excess iron from the body. Oral agents, such as <strong>deferasirox<\/strong>, are commonly used for this purpose.<\/p>\n<p class=\"isSelectedEnd\"><strong>Treatment of Neutropenia<\/strong><\/p>\n<p class=\"isSelectedEnd\">For patients with <strong>neutropenia<\/strong> associated with recurrent or severe infections, treatment with <strong>granulocyte colony-stimulating factor (G-CSF)<\/strong> may be considered to increase neutrophil production.<\/p>\n<p class=\"isSelectedEnd\"><strong>Treatment of Thrombocytopenia<\/strong><\/p>\n<p class=\"isSelectedEnd\">Patients with severe <strong>thrombocytopenia<\/strong> may require <strong>platelet transfusions<\/strong> to reduce the risk of bleeding.<\/p>\n<p class=\"isSelectedEnd\">In addition, therapies that stimulate platelet production, known as <strong>thrombopoietin receptor agonists<\/strong>, are being investigated in selected patients.<\/p>\n<p class=\"isSelectedEnd\"><strong>Immunosuppressive Therapy<\/strong><\/p>\n<p class=\"isSelectedEnd\">Selected patients with <strong>hypoplastic MDS<\/strong>, particularly younger individuals in good overall health and with specific clinical and biological characteristics, may benefit from <strong>immunosuppressive therapy<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">These treatments act by reducing immune-mediated damage to bone marrow cells, allowing normal blood-forming cells to recover and improve blood counts.<\/p>\n<p class=\"isSelectedEnd\"><strong>Allogeneic Stem Cell Transplantation<\/strong><\/p>\n<p class=\"isSelectedEnd\">Younger patients in good general condition who have persistent or severe cytopenias, do not respond adequately to conventional therapies, and have a significant risk of disease progression may be considered candidates for <strong>allogeneic stem cell transplantation<\/strong>.<\/p>\n<p>This approach remains the only treatment with the potential to achieve long-term disease eradication in selected patients.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Treatment of Higher-Risk Patients<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">Patients with <strong>intermediate-risk or high-risk MDS<\/strong> have a greater likelihood of disease progression to <strong>acute myeloid leukemia (AML)<\/strong>. For this reason, it is important to initiate appropriate treatment as early as possible.<\/p>\n<p class=\"isSelectedEnd\">The choice of therapy depends on several factors, including the <strong>biological characteristics of the disease<\/strong>, such as chromosomal abnormalities and genetic mutations, as well as the patient&#8217;s <strong>age, overall health, and comorbidities<\/strong>.<\/p>\n<p class=\"isSelectedEnd\">Treatment options may include:<\/p>\n<ul data-spread=\"true\">\n<li><strong>Hypomethylating Agents (Azacitidine):<\/strong> Azacitidine acts by reversing abnormal DNA methylation patterns that can interfere with the normal regulation of genes involved in cell growth and differentiation. Administered by subcutaneous injection, it can improve blood counts, reduce transfusion requirements, and decrease the proportion of blast cells in many patients. Clinical benefit is usually observed after several treatment cycles, and therapy is generally continued as long as it remains effective or until allogeneic stem cell transplantation is performed in eligible patients.<\/li>\n<li><strong>Intensive Chemotherapy:<\/strong> In selected patients, particularly younger individuals or those eligible for allogeneic stem cell transplantation, intensive chemotherapy regimens similar to those used for acute myeloid leukemia may be considered. The goal is to rapidly reduce the number of abnormal bone marrow cells. This treatment typically requires hospitalization in a specialized unit.<\/li>\n<li><strong>Targeted Therapies and Combination Approaches:<\/strong> Ongoing research is evaluating combinations of azacitidine with targeted therapies directed against specific molecular pathways, including <strong>BCL2<\/strong> and <strong>IDH1<\/strong>. These strategies aim to improve treatment outcomes and expand therapeutic options for patients with higher-risk disease.<\/li>\n<\/ul>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"ongoing-support\" class=\"h2_anchor\"><\/span>Ongoing Support<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">At <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong>, we provide continuous support before, during, and after treatment, accompanying each patient throughout the entire course of care and recovery.<\/p>\n\n\n\t<div id=\"block_6a3a5d0b54dce\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Management of Side Effects<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"35\" data-end=\"319\">All cancer treatments are associated with\u00a0<strong data-start=\"77\" data-end=\"93\">side effects<\/strong>\u00a0that can affect the patient\u2019s\u00a0<strong data-start=\"124\" data-end=\"143\">quality of life<\/strong>\u00a0to varying degrees. Treatments for acute leukemia may also cause significant\u00a0<strong data-start=\"221\" data-end=\"259\">physical and psychological effects<\/strong>, which can impact daily functioning and overall well-being.<\/p>\n<p data-start=\"321\" data-end=\"676\" data-is-last-node=\"\" data-is-only-node=\"\">At <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong>, attention to the patient\u2019s\u00a0<strong data-start=\"386\" data-end=\"405\">quality of life<\/strong>\u00a0remains a priority throughout the entire treatment pathway. The physicians and nurses of the\u00a0<strong data-start=\"499\" data-end=\"525\">Multidisciplinary Team<\/strong>\u00a0provide ongoing support to help manage side effects, including\u00a0<strong data-start=\"589\" data-end=\"615\">nutritional counseling<\/strong>,\u00a0<strong data-start=\"617\" data-end=\"642\">psychological support<\/strong>, and\u00a0<strong data-start=\"648\" data-end=\"675\">pain management therapy<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Supportive and Palliative Care<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">Cancer patients often have\u00a0<strong>complex needs<\/strong>\u00a0that extend beyond the treatment of the disease itself and require comprehensive,<strong>\u00a0multidisciplinary care.<\/strong><\/p>\n<p class=\"isSelectedEnd\">At <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong>, patients who need additional support have access to specialists from a range of disciplines, ensuring personalized management of cancer-related symptoms and associated conditions. Services may include nutritional counseling, physical rehabilitation, pain management, and support for other medical needs that may arise during the course of treatment and recovery.<\/p>\n<p>The goal is to\u00a0<strong>improve quality of life, promote overall well-being, and provide comprehensive care<\/strong>\u00a0tailored to each patient\u2019s individual needs.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Direct Access to Specialists<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">To ensure timely support and provide prompt answers to questions or concerns, <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong> offers a dedicated assistance service for all patients.<\/p>\n<p class=\"isSelectedEnd\">From\u00a0<strong>Monday through Friday<\/strong>, between\u00a0<strong>8:00 a.m. and 5:00 p.m.<\/strong>, patients can contact the\u00a0<a href=\"https:\/\/inoc.it\/en\/medical-area\/oncology-day-hospital\/\">Oncology Day Hospital<\/a>\u00a0Secretariat at\u00a0<strong>+39 011 993 3775<\/strong>\u00a0to request an urgent consultation.<\/p>\n<p>Patients are promptly connected with their specialist physician, ensuring rapid access to expert advice, clear information, and immediate support when needed.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Psychological Support<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"30\" data-end=\"249\">The impact of cancer also extends to the\u00a0<strong data-start=\"71\" data-end=\"95\">psychological sphere<\/strong>. A cancer diagnosis is often a\u00a0<strong data-start=\"127\" data-end=\"146\">traumatic event<\/strong>\u00a0that affects all aspects of a person\u2019s life and may generate\u00a0<strong data-start=\"208\" data-end=\"248\">anxiety, fear, anger, and depression<\/strong>.<\/p>\n<p data-start=\"251\" data-end=\"527\">At <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong>, alongside advanced medical therapies, the care pathway always includes\u00a0<strong data-start=\"360\" data-end=\"402\">specialized psycho-oncological support<\/strong>, helping patients cope not only with treatment but also with the delicate phases of\u00a0<strong data-start=\"487\" data-end=\"526\">physical and psychological recovery<\/strong>.<\/p>\n<p data-start=\"529\" data-end=\"690\" data-is-last-node=\"\" data-is-only-node=\"\">Patients may also participate in\u00a0<strong data-start=\"562\" data-end=\"594\">psychological support groups<\/strong>, where they can share experiences with others who are facing or have faced a similar condition.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Social Work Services<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"26\" data-end=\"278\">The Social Work Service at INOC &#8211; Istituto Nazionale Oncologico Candiolo provides\u00a0<strong>information, guidance, and support to patients and their families<\/strong>\u00a0regarding access to community services and the welfare and social security benefits available under current legislation.<\/p>\n<p data-start=\"280\" data-end=\"491\">During dedicated consultations, social workers assist with matters such as disability recognition, access to aids and prosthetic devices, employment-related benefits and leave, and other social support services.<\/p>\n<p data-start=\"493\" data-end=\"621\" data-is-last-node=\"\" data-is-only-node=\"\">The service is available on\u00a0<strong data-start=\"521\" data-end=\"575\">Wednesdays and Fridays from 9:00 a.m. to 1:00 p.m.<\/strong>\u00a0and can be contacted at\u00a0<strong data-start=\"600\" data-end=\"620\">+39 011 993 3059<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"multi-disciplinary-team\" class=\"h2_anchor\"><\/span>Multi Disciplinary Team<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every cancer requires a&nbsp;<strong>multidisciplinary approach<\/strong>&nbsp;at all stages of disease management. At INOC &#8211; Istituto Nazionale Oncologico Candiolo, this is provided by a team of specialists from various clinical and surgical departments, known as the&nbsp;<strong>GIC<\/strong>, Interdisciplinary Care Group (or MDT). The GIC ensures that each patient is supported throughout the diagnostic and therapeutic process, including arranging and coordinating examinations and maintaining communication with the patient and their family.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For each patient, the GIC (MDT) defines and shares a personalized care pathway based not only on the type and stage of the tumor but also on the patient\u2019s individual characteristics. The goal is to achieve the best possible outcomes both oncologically and functionally, while maintaining a high quality of life.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"clinical-divisions\" class=\"h2_anchor\"><\/span>Clinical Divisions<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The diagnostic and therapeutic pathway for <strong>myelodysplastic neoplasms (MDS)<\/strong> at <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong> involves close collaboration among several specialized clinical divisions, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/medical-oncology\/\" type=\"medical-area\" id=\"5169\">Medical Oncology<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/oncology-day-hospital\/\" type=\"medical-area\" id=\"5183\">Day Hospital<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/laboratory-analysis\/\" type=\"medical-area\" id=\"5113\">Laboratory Analysis<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/pathologic-anatomy\/\" type=\"medical-area\" id=\"5118\">Anatomical Pathology<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"research-and-clinical-studies\" class=\"h2_anchor\"><\/span>Research and Clinical Studies<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Researchers at <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong> are actively involved in national and international projects focused on <strong>myelodysplastic neoplasms (MDS)<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The Institute is part of the national network of the<a href=\"https:\/\/www.fisimematologia.it\/\"> <strong>Italian Myelodysplastic Syndromes Foundation (FISIM)<\/strong><\/a> and the <strong><a href=\"https:\/\/www.gimema.it\/en\/\">GIMEMA Foundation<\/a><\/strong>, which allows access to advanced molecular analyses and provides patients with the most up-to-date diagnostic and therapeutic opportunities. All activities are conducted in accordance with national and international guidelines and include participation in <a href=\"https:\/\/inoc.it\/en\/medical-area\/clinical-research-unit-cru\/\"><strong>experimental clinical trials<\/strong>.<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A key objective is to collaborate with a broad network of researchers in order to collect robust clinical data and draw reliable conclusions on the effectiveness of new therapeutic approaches for MDS.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Over the years, the Institute has made available to patients several <strong>state-of-the-art therapies<\/strong>, including drugs that are not yet widely licensed or commercially available. These innovative \u201ctargeted\u201d therapies act on specific molecular pathways and may be used alone or in combination with approved treatments, with the aim of improving treatment efficacy and patient outcomes in MDS.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"why-choose-us\" class=\"h2_anchor\"><\/span>Why Choose Us<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">At <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong>, every patient with <strong>myelodysplastic neoplasms (MDS)<\/strong> is managed according to highly specialized standards through the coordinated work of a dedicated <strong><a href=\"https:\/\/inoc.it\/en\/pathology\/myelodysplastic-neoplasms\/#multi-disciplinary-team\">Interdisciplinary Care Group (GIC)<\/a><\/strong>.<\/p>\n\n\n\t<div id=\"block_6a3a5d0b54e1e\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Clinical Experience and Tailored Approach<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>Thanks to the large number of cases treated each year, INOC &#8211; Istituto Nazionale Oncologico Candiolo is a\u00a0<strong>national reference<\/strong>\u00a0center for the care of this disease. This extensive experience allows us to manage even the most complex cases, always using a\u00a0<strong>personalized approach<\/strong>, tailored to the clinical and individual profile of each patient.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Imaging Technologies and Advanced Diagnostics<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>Establishing a treatment plan always begins with an accurate and timely diagnosis. Patients have access to\u00a0<strong>state-of-the-art imaging technologies<\/strong>, such as ultrasound, contrast-enhanced CT, MRI, and cholangio-RM, which are critical for accurately assessing the extent of the tumor.<\/p>\n<p><strong>Advanced laboratory tests<\/strong>, including molecular analyses, are also available to help define biological features of the disease and guide treatment choices.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Clinical Research and Access to Trials<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><!-- \/wp:heading --><\/p>\n<p>As an IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare), INOC &#8211; Istituto Nazionale Oncologico Candiolo combines clinical care with a strong focus on scientific research. Patients can be considered for<a href=\"https:\/\/inoc.it\/en\/pathology\/myelodysplastic-neoplasms\/#research-and-clinical-studies\">\u00a0<\/a><strong>participation in active clinical trials<\/strong>, offering access to innovative therapies not yet available in standard practice. This integration of care and research is a distinctive strength that translates into tangible benefits for patients.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Care and Support Every Step of the Way<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>The Interdisciplinary Care Group\u00a0(GIC or MDT)\u00a0<strong>supports th<\/strong><strong>e patient at every stage<\/strong>: from diagnosis, through treatment, to follow-up. Special attention is paid to<strong>\u00a0nutritional support, psychological health and reintegration into daily life.<\/strong>\u00a0The organization of checkups, examinations, and treatment is designed to ensure\u00a0<strong>continuity, serenity, and a humane, caring<\/strong>\u00a0approach to each patient\u2019s needs.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n","protected":false},"featured_media":0,"template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"class_list":["post-5223","pathology","type-pathology","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Myelodysplastic Neoplasms - INOC - Istituto Nazionale Oncologico Candiolo<\/title>\n<meta name=\"description\" content=\"Myelodysplastic neiplasias: causes, symptoms, diagnosis, and available therapies. 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