Treating myelodysplastic syndromes

The myelodysplastic syndromes (MDS) are a diverse group of disorders of hematopoietic stem cells that are characterized by ineffective hematopoiesis, and a variable risk of transformation to acute myeloid leukemia. The prognosis (as estimated by the International Prognostic Scoring System), co-morbidities and age of a patient must all be considered when deciding treatment strategies. Therapeutic modalities vary from supportive care to allogeneic stem cell transplantation (SCT), and growth factors and immunosuppressive therapy may benefit selected patients. The re-emergence of compounds such as thalidomide and arsenic trioxide, and new 'targeted therapy', such as DNA methlytransferase inhibitors and farnesyl tranferase inhibition, provide novel therapeutic options. Furthermore, development of reduced intensity conditioning regimens may result in more patients with MDS benefiting from SCT approaches.