Therapeutic algorithm in HR-MDS patients. The different therapeutic options for HR-MDS patients. The first step is to determine whether the patient is potentially fit and eligible for an allo-HSCT. Pretransplant options may vary depending on disease burden and donor availability, whereas iron chelation is recommended until allo-HSCT. At all stages, the patient should be evaluated for a potential clinical trial option. Patients progressing to AML may take advantage of recent approval of targeted therapies including IDH or FLT3-inhibitors. CTx, chemotherapy; IC, induction chemotherapy; SC, best supportive care; TKI; tyrosine kinase inhibitor. *These could be IDH or FLT3-inhibitors (not presently approved). †Consider posttransplant disease surveillance strategies.