title: Immune alterations in untreated and treated myelodysplastic syndrome.
abstract: BACKGROUND
  Current literature suggests a variety of immune abnormalities are present in myelodysplastic syndrome (MDS) patients. However, they have not been comprehensively characterized or systematized to date. As a result, their clinical implications remain largely unknown. In addition, an increased incidence of various autoimmune conditions has been documented in MDS patients.
  
  
  METHODS
  The authors offer a comprehensive review of the existing literature on immune mechanisms involved in the pathogenesis of MDS, various immune abnormalities documented in its course, their link with the clonal evolution of MDS as well as immune alterations induced by the existing MDS therapies.
  
  
  CONCLUSIONS
  The course of MDS is accompanied by complex immune alterations, including T-cell and NK-cell defects, decreased functional abilities of neutrophils and antigen-presenting cells, altered antibody and cytokine production. While contemporary MDS therapies are shown to possess some immunomodulatory properties, authentic autoimmune conditions have also been documented with lenalidomide and recombinant erythropoietin. Caution should be exerted with the use of these agents in MDS patients with evidence of autoimmune disorders, as exacerbation of autoimmune phenomena can be anticipated. While the heterogeneity of MDS represents an inherent limitation, integration of emerging information from molecular biology, genetics, immunology research and clinical practice could translate into improved outcomes of this disease spectrum.
authors.affiliation: University of Connecticut, Department of Medicine, 24 Park Pl, Apt 20A, Hartford, Farmington, CT-06106, USA. drprerna@gmail.com
authors.forename: Prerna
authors.initials: P
authors.lastname: Mewawalla
authors.forename: Constantin A
authors.initials: CA
authors.lastname: Dasanu
mesh_terms: D000818:Animals; D015551:Autoimmunity / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007107:Immune System / Q000187:drug effects / Q000503:physiopathology; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000276:immunology* / Q000473:pathology