Recent advances in the management of therapy-related myelodysplastic syndromes and acute myeloid leukemia.
OBJECTIVE
Therapy-related myelodysplastic syndromes and acute myelogenous leukemia (t-MDS/AML) comprise an increasingly common, poor-risk disease cohort without standard treatment options. This review describes available treatments and recent advances that may influence the clinical management of t-MDS/AML.


RESULTS
Multiple retrospective studies have identified poor-risk cytogenetics, chemotherapy resistance, comorbidities from prior cancer and therapy, and persistence of the primary malignancy as factors that contribute to poor clinical outcomes of t-MDS/AML. Recent analyses show that t-MDS/AML can respond to standard therapy, but responses are less durable. In most cases, cure is made more likely with allogeneic stem cell transplantation. These findings suggest that improved survival may result from earlier, low-intensity nontransplant therapy, and aggressive pursuit of reduced-intensity transplant approaches in eligible individuals coupled with posttransplant relapse prevention strategies. Molecular characterization of t-MDS/AML may aid future clinical management decisions and identify targets for therapy.


CONCLUSIONS
Data emerging from recent t-MDS/AML studies are shedding light on factors that contribute to disease biology and poor clinical outcomes. These findings can be used to develop strategies to improve the treatment and survival of patients with t-MDS/AML.
Department of Medicine, Leukemia Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA. klimekv@mskcc.org
Virginia M
VM
Klimek
D016026:Bone Marrow Transplantation; D064420:Drug-Related Side Effects and Adverse Reactions; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000209:etiology / Q000628:therapy*; D009190:Myelodysplastic Syndromes / Q000209:etiology / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000209:etiology / Q000628:therapy*; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors
D004791:Enzyme Inhibitors