Whilst peer-reviewed published guidelines have appropriate scrutiny and endorsement to support their validity, the reality is that these often become at least partially outdated soon after publication. In developing the latest iteration of guidelines for the diagnosis and management of MDS, the European LeukemiaNet MDS guideline group, has sought to create a web-based interface that is interactive, portable, and capable of dynamic updating at least annually. The guideline development process involved systematic literature review, expert opinion, and scenario analysis. The faculty was diverse; from 18 European countries. The group included Junior Faculty who fed back on content and the practicality for access from mobile devices. The final product is interactive and iterative, with upfront ’headline’ recommendations supported by expanded information pages for readers requiring further detail [https://mds-europe.org/]. Examples of updates from our previous ELN guidance are:

Diagnosis: we suggest mutation analysis in all patients where available, to inform prognosis and management. We explain the strengths and the limitations of current knowledge, including discussion of the clonal cytopenias. We also include consideration of germline predisposition syndromes.

Prognosis: we provide calculation tools for IPSS-R and will update this with the forthcoming IPSS-Mol during late 2021/2022.

Low-risk MDS: we describe new data for iron chelation, for early use of Erythropoietic Stimulating Agents and for novel agents such as Luspatercept. Pathways for use of these agents are presented.

High-risk MDS: recommendations are given for the use of hypomethylating agents, chemotherapy, and allogeneic stem cell transplant. An interactive stem cell transplant algorithm including comorbidity is available to guide transplant decisions.

This project was supported by Horizon 2020 funding under the auspices of the MDS-RIGHT programme. The guidelines have recently been endorsed by the European Haematology Association. Discussions are ongoing with international colleagues such that the website may accommodate international variation of recommendations.