American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended management for patients with low-risk myelodysplastic syndrome?

1. Chemotherapy

2. No treatment

3. Bone marrow transplant

4. Supportive care

The correct answer is: No treatment

The recommended management for patients with low-risk myelodysplastic syndrome (MDS) typically involves no treatment, especially in cases where patients have asymptomatic or mild disease and show stable blood counts. This approach stems from the understanding that many low-risk MDS patients may endure a prolonged period without significant symptoms or complications. In essence, the rationale behind the "no treatment" option is rooted in the concept of watchful waiting. This approach is often favored because intervention through aggressive treatment, such as chemotherapy or stem cell transplantation, can lead to unnecessary toxicity without providing substantial benefit in terms of survival or quality of life. As a result, monitoring the patient’s health closely while allowing for natural disease progression is a common and effective management strategy in such scenarios. While supportive care may play a role in managing symptoms or complications that arise, it does not equate to treatment for the underlying disorder and is often employed alongside the watchful waiting strategy. In contrast, options like chemotherapy or bone marrow transplant are generally reserved for higher-risk patients who exhibit poorer prognoses, significantly symptomatic disease, or evidence of acute transformation. Therefore, in low-risk cases, the conservative approach of no active treatment is the most suitable course of action.