High-risk myelodysplastic syndromes: chemotherapy, transplantation, and beyond.
Allogeneic hematopoietic cell transplantation (HCT) has curative potential for patients with myelodysplastic syndromes (MDS), though with considerable nonrelapse mortality and morbidity. The International Prognostic Scoring System, despite its confines, remains a widely used tool guiding treatment decisions in MDS. The two hypomethylating agents, 5-azacytidine (azacitidine) and 5-aza-2-deoxycytidine (decitabine), are both effective in high-risk MDS, but about 50% of high-risk MDS patients fail to achieve a meaningful response, and these agents offer only a modest survival benefit, with a median response duration of 13 months. The more recent proposed risk models of MDS, as well as modern transplant strategies and expanded alternative donor sources, have helped to increase the number of patients offered curative treatment. As both drug therapy and HCT modalities evolve, treatment decisions are certain to become more complex. Current therapeutic options should view the hypomethylating agents as a way to optimize disease response before (and possibly after) HCT.
Gergis
Usama
U
Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY 10065, USA. usg2001@med.cornell.edu
Wissa
Usama
U
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001374:Azacitidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D001803:Blood Transfusion; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D019175:DNA Methylation / Q000187:drug effects; D015257:DNA-Cytosine Methylases / Q000037:antagonists & inhibitors; D000077209:Decitabine; D005544:Forecasting; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009190:Myelodysplastic Syndromes / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D019172:Transplantation Conditioning / Q000379:methods
D000964:Antimetabolites, Antineoplastic; D000077209:Decitabine; D015257:DNA-Cytosine Methylases; D001374:Azacitidine