Management of myelodysplastic syndromes in the geriatric patient

The majority of patients with myelodysplastic syndromes (MDS) are older, and the incidence of these diseases is rising as the population ages. Clinicians are often uncertain about how to identify patients who may benefit from specific treatment strategies. The International Prognostic Scoring System is a widely used tool to assess risk of transformation to leukemia and guide treatment decisions, but it fails to take into account many aspects of treating elderly patients, including comorbid illness, secondary causes of MDS, prior therapy for MDS, and other age-related health, functional, cognitive, and social problems that affect outcome. Patients with lowrisk disease traditionally have been given supportive care, but evidence is increasing that treatment with lenalidomide or methyltransferase inhibitors may influence the natural history of the disease and should be used in conjunction with supportive-care measures. Supportive care of these patients also could be improved to enhance their quality of life and functional performance.