What are the treatments for low risk and high risk MDS?

What are the treatments for low-risk and high-risk MDS? So for low-risk MDS, as I said, the treatment is supportive most of the times. If they have low hemoglobin and if their erythropoietin level is low, particularly less than 200, they get erythropoietin stimulating agents like RNs or Procrit and sometimes other supportive medications like Danazol to improve the red cells. If they have low platelet count or if they have low white cell count, sometimes they can get prophylactic antibiotics and also medications to stimulate the bone marrow. Particularly one low-risk MDS category called 5Q-. In this disease, it has been shown that Revlimid or Lenalidomide that is used most commonly in myeloma has been shown to be very effective in that particular category of disease. So if somebody has 5Q- or 5Q deletion syndrome, MDS, they get Lenalidomide and they have more than 90% chance of response to the treatment. So other than supportive care and Lenalidomide, most of the low-risk patients watched more closely and if they get transfused a lot and if they're iron overloaded, then they get medications to get rid of that excess iron. In high-risk MDS patients, the standard of care is treating with hypomethylating agent like either Azacetidine or Decytabine and as I said earlier, the response rate to them is 50%. So we are trying to improve upon that. One of the clinical trial that we are doing is adding the CD47 antibody to MDS patients to the hypomethylating agent. So far, the preliminary data seems to be very promising with close to 90% response with addition of these two drugs. But that is only phase one. We are looking into more phase two and phase three now. So that is one promising treatment and as I said earlier, the treatments that are tried in AML like the targeted treatments, FLIT3 inhibitors, IDH inhibitors are also being looked into in MDS where it is appropriate. And also there are studies going on where combining with Venetoclax, which is already approved in AML. So those are different types of treatments. But one important thing I wanted to share with you today is there is a recent study presented in the ASH meeting last year in 2020 that showed patients up to age 75 because MDS is, as we already discussed, patients in older patients. And that study showed patients who are up to age 75 who got transplanted, they had improved survival compared to patients who did not get transplanted. The study was randomized based on patient, you know, if they have a donor or not. You know, it's not randomized, but you know, it is randomized based on the availability of the donor or not. And it showed patients who have donors had more than 20% chance of living after five years compared to patients who did not have donors. So even not all the patients who have donors did not get transplanted ultimately. And it was much more, you know, the survival and everything was much better in patients who actually underwent transplant. So I think at this point, transplant is the only cure for MDS and for that part, most of the leukemia, except good risk leukemia, and patients who underwent transplant up to age 75, especially in high risk MDS, shown significant survival advantage. So I think transplant should be considered as a treatment option for all the patients, you know, in MDS and unless, you know, if they can't do it.