Strategies for achieving transfusion independence in myelodysplastic syndromes.
Myelodysplastic syndromes (MDS) are a group of complex diseases of the myeloid stem cell that result in chronic cytopenias. In some instances, these disorders may progress to acute myeloid leukemia. Patients with MDS frequently experience chronic, symptomatic anemia, and many become dependent on chronic transfusions of packed red blood cells. However, long-term transfusion dependence has clinical and economic consequences, including a potentially negative impact on patients' quality of life (QOL). Recently, studies have investigated various strategies to reduce or eliminate transfusion needs in MDS patients. Supportive measures with hematopoietic growth factors such as erythropoietin are often less effective in MDS-associated anemia than in anemia from other causes, but some patients may benefit from this approach. Treatment with other agents, such as antithymocyte globulin, azacitidine, decitabine, thalidomide, and lenalidomide, has resulted in transfusion independence in some subsets of MDS patients. Nurses who care for patients with MDS should be aware of the impact of transfusion dependence on the patient's QOL, as well as the benefits and risks of the various other treatment options available to these patients. Such knowledge will enable the nurse to provide accurate, relevant information, so that patients can make informed choices regarding treatment options for MDS.
Thomas
Mary Laudon
ML
VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA. mary.thomas4@va.gov
D000740:Anemia / Q000209:etiology / Q000628:therapy; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D000964:Antimetabolites, Antineoplastic / Q000191:economics / Q000627:therapeutic use*; D001374:Azacitidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077209:Decitabine; D016527:Drug Costs; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000191:economics; D004921:Erythropoietin / Q000627:therapeutic use; D006301:Health Services Needs and Demand; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics / Q000627:therapeutic use*; D007258:Informed Consent; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000523:psychology / Q000628:therapy*; D024802:Nurse's Role; D009859:Oncology Nursing / Q000458:organization & administration; D010353:Patient Education as Topic; D018579:Patient Selection; D011788:Quality of Life; D013792:Thalidomide / Q000627:therapeutic use; D016896:Treatment Outcome
D000961:Antilymphocyte Serum; D000964:Antimetabolites, Antineoplastic; D007166:Immunosuppressive Agents; D004921:Erythropoietin; D013792:Thalidomide; D000077209:Decitabine; D001374:Azacitidine