title: Update on the pharmacotherapy for myelodysplastic syndromes.
abstract: BACKGROUND
  For many decades, myelodysplastic syndromes (MDS) were a poorly understood disease group with no approved therapies, and patient management largely relied upon supportive care and intensive chemotherapy. The last decade has seen many scientific and therapeutic advances culminating in the US FDA approval of three drugs for the treatment of these complex malignancies: lenalidomide, azacitidine and decitabine.
  
  
  METHODS
  This review summarizes the major prognostic risk models that guide treatment decisions and examines the available literature on the mechanism of action and efficacy of each of the approved agents. The authors also discuss evidence supporting the use of other therapies that have entered the standard of care including growth factors, immunosuppressive therapy and stem-cell transplantation.
  
  
  CONCLUSIONS
  While significant progress has been made in understanding the molecular basis of MDS, much of this has yet to translate into therapeutic benefit. Each of the available treatment modalities has shortcomings, and both combination strategies and novel agents are under investigation in clinical trials to improve outcomes.
authors: University of Maryland, Marlene and Stewart Greenebaum Cancer Center , 22 S. Greene St. S9D04B, Baltimore, MD 21201-1595 , USA.
authors: Vu H
authors: VH
authors: Duong
authors: Rami S
authors: RS
authors: Komrokji
authors: Alan F
authors: AF
authors: List
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001374:Azacitidine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D015254:DNA Modification Methylases / Q000037:antagonists & inhibitors; D000077209:Decitabine; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D000077269:Lenalidomide; D009190:Myelodysplastic Syndromes / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D011379:Prognosis; D012074:Remission Induction; D018570:Risk Assessment; D013792:Thalidomide / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D020533:Angiogenesis Inhibitors; D000964:Antimetabolites, Antineoplastic; D007155:Immunologic Factors; D013792:Thalidomide; D000077209:Decitabine; D015254:DNA Modification Methylases; D000077269:Lenalidomide; D001374:Azacitidine
keywords: azacitidine; darbepoetin; decitabine; epoetin; lenalidomide; myelodysplastic syndrome