Is there an advantage to early therapy with hypomethylating agents for high/very high risk patients with MDS who are not transplant candidates and have only mild cytopenias?

NCCN does not offer observation as an option for patients in this higher risk group. Is it reasonable to observe until cytopenias worsen or blast count worsens?

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Is there an advantage to early therapy with hypomethylating agents for high/very high risk patients with MDS who are not transplant candidates and have only mild cytopenias?

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