Dr Komrokji on the Importance of Establishing a Clinical Consensus Regarding the Use of Molecular Testing in MDS

"[Having] a consensus group that [treat MDS] on a daily basis is [important] and well geared to [discuss] the most practical [treatment options], and [compare] what [treatments] we would recommend. This is a gap that's unfilled and needs more [attention]."

Rami Komrokji, MD, vice chair, Malignant Hematology Department, Moffitt Cancer Center, discusses the evolving role of molecular testing in myelodysplastic syndromes (MDS) and the necessity of establishing consensus guidelines to standardize its use in clinical practice. These considerations were highlighted in a discussion at the 2025 Bridging The Gaps: Leukemia, Lymphoma, and Multiple Myeloma Meeting in Miami, Florida.

The landscape of MDS management continues to evolve with advancements in disease biology and molecular testing capabilities, Komrokji begins. Initially confined to academic centers, molecular testing has now become a critical component of routine clinical practice. Komrokji emphasizes that the widespread adoption of molecular testing is essential, as it can directly inform treatment selection, prognostication, and transplant eligibility. Despite this progress, gaps remain between evidence-based recommendations and real-world implementation, particularly in community oncology settings, he explains.

One of the primary challenges in integrating molecular testing into standard practice is determining the appropriate timing and scope of testing. Komrokji notes that expert consensus is needed to establish when testing should be performed and which genetic panels should be prioritized to ensure comprehensive yet practical evaluation. Standardization of molecular testing enables clinicians to make more informed treatment decisions and improve prognostic accuracy, he says.

Molecular profiling plays a pivotal role in tailoring therapy for MDS, particularly in refining risk stratification and guiding treatment choices. The ability to identify key mutations allows for more personalized therapeutic approaches, including the selection of targeted agents and the assessment of transplant candidacy. Komrokji underscores that molecular testing has shifted from being an academic tool to an integral component of everyday clinical decision-making.

Given the complexity of MDS and the heterogeneity of molecular alterations, a structured approach to testing is necessary. Komrokji advocates for the establishment of expert-driven consensus guidelines that outline best practices for molecular testing in MDS. Such guidelines could help bridge the gap between research findings and their application in community oncology settings, ensuring that patients receive optimal, evidence-based care.

As molecular testing becomes increasingly integrated into MDS management, ongoing efforts to standardize its use remain essential in improving patient outcomes. Future initiatives should focus on refining molecular classification systems, optimizing testing strategies, and translating emerging data into actionable clinical recommendations.