[Myelodysplastic syndromes--new treatment options]

Myelodysplastic syndromes (MSD) are acquired disorders of the bone marrow, characterized by defects in maturation and function of hematopoietic stem cells, ineffective hemopoiesis and risk of evolution to acute leukemia. Using prognostic scoring systems like the IPSS (International Prognostic Scoring System) or the Düsseldorf Score allows to predict the course of the disease, separating low-risk patients from high-risk patients. In the past, transfusion of red cells was the only treatment in the vast majority of patients. Today, there are promising drugs available, either within treatment studies or in the near future approved by health authorities. Low-risk patients may respond to antithymocyte globulin, valproic acid and Revlimid in 5q-patients. Erythropoietin (EPO) +/- granulocyte colony-stimulating factor (G-CSF) should be administered in patients with a low EPO level. High-risk patients aged < 60 years can be cured by allogeneic stem cell transplantation. Older high-risk patients are likely to respond to epigenetic treatment with 5-azacytidine or decitabine, even in case of chromosomal anomalies. After exact diagnosis using FAB and/or WHO classification and evaluation of prognosis, patients should be treated according to their individual profile. In the near future, the aim is not only to improve quality of life but also to prolong life expectancy.