Myelodysplastic syndromes: a challenging disease for patients and physicians.
The biological mechanisms underlying the ineffective haematopoiesis and increased risk of leukaemic evolution in MDS is largely known. A careful clinical and cytogenetical assessment is required to correctly classify and risk stratify the patients. A curative approach with allogeneic stem cell transplantation should always be considered at the initial assessment. In low-risk patient receiving chronic RBC transfusions, symptomatic iron-overload is a reality and carries a significant mortality, and therefore, the iron status should be monitored and chelators used when indicated. The first line treatment of anaemia is erythroid growth factors. Lenalidomide is a highly potent therapy in low-risk MDS with del 5q, however, the treatment carries a high risk of rapidly developing neutropenia and thrombocytopenia. Several promising drugs are currently under investigation in low-risk MDS including thrombopoietin analogues and epigenetically active drugs.
Department of Medical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan.
Naresh
N
Somani
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001803:Blood Transfusion; D003582:Cytogenetics; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D007502:Iron Chelating Agents / Q000627:therapeutic use; D000077269:Lenalidomide; D009190:Myelodysplastic Syndromes / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D033581:Stem Cell Transplantation; D013792:Thalidomide / Q000031:analogs & derivatives / Q000627:therapeutic use
D000970:Antineoplastic Agents; D006397:Hematinics; D007502:Iron Chelating Agents; D013792:Thalidomide; D000077269:Lenalidomide