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Use of Hematopoietic Stem Cell Transplantation to Assess the Origin of Myelodysplastic Syndrome
Published on: October 3, 2018
Treatment of acute myeloid leukemia with antecedent myelodysplastic syndrome
1Department of Medicine, University of Chicago Pritzker School of Medicine, Il 60637-1463, USA.
Abstract:
Primary myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) are both age-related, with increasing prevalence over age 60. The poor outcome of treatment for elderly AML patients is due both to host-related and intrinsic biologic factors. Some elderly patients have documented MDS for months or years before presenting with AML. Many more, though, have dysplastic morphology in bone marrow and blood cells that suggests an occult preleukemic phase. Cytotoxic chemotherapy in elderly patients has a high morbidity and mortality due to comorbid diseases, diminished tolerance to prolonged pancytopenia, and decreased drug metabolism and excretion; doses, therefore, are often attenuated. The low response rates to conventional remission-induction chemotherapy regimens suggest both intrinsic drug resistance and diminished normal hematopoietic precursors to regenerate following therapy. Less intensive chemotherapy has the potential for less organ toxicity, less hospitalization, and less expense. However, attenuated chemotherapy has the major disadvantage of less antileukemic activity and, as yet, the survival benefit for this approach remains unproven. Nevertheless, low-dose ara-C (cytarabine) therapy for 2 to 3 weeks may be beneficial for some patients. The standard response criteria used with acute leukemia to measure disease eradication may not be appropriate for patients with MDS evolving to AML.
Insights
Elderly patients with myelodysplastic syndrome (MDS) evolving to acute myeloid leukemia (AML) often have poor treatment outcomes. Lower-intensity chemotherapy, like low-dose cytarabine, may offer benefits but requires adjusted response criteria.
Area of Science:
- Hematology
- Geriatric Medicine
- Oncology
Background:
- Primary myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) are age-related hematologic malignancies.
- Elderly patients with AML face poor treatment outcomes due to host factors and disease biology.
- Many elderly AML patients exhibit dysplastic changes suggesting an occult preleukemic phase.
Purpose of the Study:
- To discuss treatment challenges and potential strategies for elderly patients with MDS evolving to AML.
- To evaluate the efficacy and limitations of conventional and less intensive chemotherapy regimens.
- To highlight the need for modified response criteria in this patient population.
Main Methods:
- Review of existing literature on MDS and AML in the elderly.
- Analysis of treatment toxicities and response rates associated with different chemotherapy intensities.
- Discussion of the potential role of low-dose cytarabine (ara-C).
Main Results:
- Elderly patients have diminished tolerance to cytotoxic chemotherapy due to comorbidities and reduced drug metabolism.
- Conventional chemotherapy shows low response rates and high morbidity/mortality in this group.
- Less intensive chemotherapy may reduce toxicity but has unproven survival benefits and potentially lower antileukemic activity.
Conclusions:
- Attenuated chemotherapy, such as low-dose cytarabine, may be beneficial for select elderly AML patients.
- Standard acute leukemia response criteria may not be suitable for assessing treatment efficacy in MDS evolving to AML.
- Further research is needed to establish survival benefits and optimize treatment approaches for this demographic.
