Current treatment options and strategies for myelodysplastic syndromes.
BACKGROUND
The myelodysplastic syndromes (MDS) are a group of heterogeneous disorders characterized by ineffective hematopoiesis. A number of scoring systems have been developed but they are of limited value in guiding individual patient treatment decisions.


OBJECTIVE
We have presented the benefits and limitations of various treatment approaches for MDS to help provide guidance in treatment decisions.


METHODS
An extensive literature search on PubMed from 2000 to 2008 was done using MESH keywords MDS, treatment, 5-azacytidine, decitabine, lenalidomide, antithymocyte globulin.


CONCLUSIONS
In recent years there has been progress in supportive care and three agents have been approved for the treatment of MDS. With the exception of lenalidomide, which produced remarkable responses with 5q chromosomal deletion, these therapies benefit a minority of patients and the overall outcomes are still unsatisfactory. Allogeneic stem cell transplant remains the only curative option but the majority of MDS patients are not eligible because of older age and other medical problems. Immunosuppressive therapy is helpful in a fraction of patients. Several newer agents are being tested, offering promise for the future.
Wayne State University School of Medicine, Karmanos Cancer Institute, Division of Hematology/Oncology, Detroit, MI 48201, USA.
Sridhar
S
Srinivasan
Charles A
CA
Schiffer
D000367:Age Factors; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000627:therapeutic use; D001803:Blood Transfusion; D002986:Clinical Trials as Topic; D015897:Comorbidity; D018450:Disease Progression; D004921:Erythropoietin / Q000627:therapeutic use; D051231:Farnesyltranstransferase / Q000037:antagonists & inhibitors; D006397:Hematinics / Q000627:therapeutic use; D056572:Histone Deacetylase Inhibitors; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D009190:Myelodysplastic Syndromes / Q000628:therapy*; D010087:Oxides / Q000627:therapeutic use; D011994:Recombinant Proteins; D012923:Social Class; D033581:Stem Cell Transplantation
D000964:Antimetabolites, Antineoplastic; D001152:Arsenicals; D006397:Hematinics; D056572:Histone Deacetylase Inhibitors; D007155:Immunologic Factors; D010087:Oxides; D011994:Recombinant Proteins; D004921:Erythropoietin; D051231:Farnesyltranstransferase; D000077237:Arsenic Trioxide