Progress in the therapy of myelodysplastic syndromes

The progress in the therapy of the myelodysplastic syndromes has been far from spectacular during recent years. No currently available treatment has been shown to be consistently effective in producing sustained improvement in hematopoiesis or in delaying leukemic evolution. With regard to both quantity and quality of life, no other treatment has been proven superior to classical supportive treatment, with the possible exception of bone marrow transplantation in younger patients. While in selected cases anecdotal successes have been noted with the use of hormonal therapy, some differentiation inducers, e.g. vitamin A- en D-analogues, have not hold their promises in placebo controlled trials. Attempts to induce complete remissions in MDS with antileukemic treatment have usually been unsuccessful. Toxicity is substantial and a considerable proportion of patients fare worse with chemotherapy than with standard supportive care. Recently, a flood of reports has appeared on the use of biological response modifiers e.g. cytokines and growth factors in the treatment of MDS. Perhaps some of these hold promises for a new era in MDS, but the data are preliminary and no follow-up on long term survival is at hand.