[Current management of myelodysplastic syndromes]

Recent progresses have changed the paradigms for the treatment of MDS. Careful patient screening and prognostic stratification using IPSS score is necessary before any treatment decision. For lower-risk MDS where anemia is the major problem, treatment with ESA should be considered first. In patients who require red blood cells transfusions, iron overload must be monitored carefully in order to consider iron chelation therapy. A new drug such as lenalidomide which is active in MDS with del5q is currently under investigation in non-del5q MDS. For patients with higher-risk MDS, AML transformation is the major issue. Therefore aggressive treatment approaches such as allogeneic HSC transplant or intensive chemotherapy can be offered to selected subsets of patients. However, for the vast majority, demethylating agents and namely 5-azacytidine currently represent the standard of care. Patient information and participation in clinical trails are important aspects of the current management of MDS.