Recent advances in low- and intermediate-1-risk myelodysplastic syndrome: developing a consensus for optimal therapy

Myelodysplastic syndrome (MDS) is relatively common, with an incidence estimated as high as 50 cases per 100,000 people per year. This cancer mainly affects older (>or=60 years) patients. MDS refers to a collection of hematologic malignancies that share an ineffective production, or hematopoiesis, of normal bone marrow or myeloid cells. As progressive bone marrow failure occurs, patients generally display gradually worsening cytopenias specific to the type of bone marrow cell affected, such as thrombocytopenia or neutropenia. MDS patients often develop disease-related anemia requiring chronic blood transfusion; this can lead to complications including iron overload. As MDS progresses and the number of bone marrow blasts increases, the disease transforms into acute myelogenous leukemia (AML). Several classification systems have been developed to identify and differentiate particular types of MDS. Proper identification is essential, allowing the oncologist to determine prognosis, as well as the optimal therapeutic strategy. Several agents have been developed or are under investigation for the treatment of MDS, with the therapeutic goal of increasing survival and decreasing the rate of AML transformation. Currently, 3 agents are FDA-approved: azacitidine, decitabine, and lenalidomide. This clinical roundtable will discuss the optimal management of patients with each of these approved therapies, as well as the various classification systems used to differentiate MDS subtypes for treatment.