[The myelodysplastic syndrome II. New therapeutic principles, course and prognosis]

The treatment of the myelodysplastic syndrome (MDS) has formerly been supportive, primarily blood transfusions. Treatment with the growth factor erythropoietin, in combination with granulocyte-colony stimulating factor or granulocyte-macrophage colony stimulating factor is accompanied by a decline in the need for blood transfusions in about 40% of the patients. Likewise, the risk of infections is reduced. Immunosuppressive therapy with cyclosporine and antithymocyte globulin is also capable of improving the cytopenia in about 50% of the patients. Allogeneic bone marrow transplantation is the only possibility of cure in MDS, but the procedure is associated with high mortality. This treatment modality is therefore only recommended for younger patients, who are in a complete remission after being treated for acute myeloid leukaemia or are otherwise in a high risk group. The prognosis is poor, with an overall median survival of about 15 months. A simple scoring system has been elaborated and is based upon the percentage of myeloblasts in the bone marrow, a chromosomal analysis, and the number of cell lines with cytopenia. This system is able to distinguish between three distinct groups of patients with a highly different prognosis (low, intermediate, high risk), which is also of importance when evaluating the best treatment for the individual patient.