These suggested practice guidelines are based on extensive evaluation of the reviewed risk-based data and indicate useful current approaches for managing patients with MDS. Given the limited number of studies comparing different therapies in MDS, most of the therapeutic drugs used to treat this disease should be assessed in the context of clinical trials. Several clinical trials are ongoing to assess the efficacy of novel biospecific agents in this disease. The role of thrombopoietic cytokines for management of thrombocytopenia in MDS needs further evaluation. In addition, further determination of the effects of these therapeutic interventions on the patient's quality of life is important. Progress toward improving management of MDS has occurred over the past few years, and more such advances are anticipated using these guidelines as a framework for coordination of comparative clinical trials. © Journal of the National Comprehensive Cancer Network.