Treatment and prognostic factors in myelodysplastic syndromes

While MDS remains an enigmatic disease, substantial progress has been made in the elucidation of its origin and the better understanding of its natural course. The advent of newer molecular and cytogenetic techniques has tremendously improved the 'older' morphological and histopathological prognostic criteria. More refined scoring systems may ultimately allow for individualized treatment programmes which will better preserve quality of life, while at the same time offer improved chances for survival and cure. Much can be expected from newer cytokines, such as thrombopoietin, stem cell factor, interleukin-11 or of the combination of different cytokines and growth factors, to alleviate MDS-symptoms and to possibly alter the course of the disease. After the initial disappointment with differentiation inducers, the availability of newer agents and/of combinations may offer better perspectives for the future. Much interest will also be generated on the use of mdr-reversal agents in the attempts to improve on chemotherapeutic efficacy. Finally, while allogeneic transplantation still remains the only option for definite cure of the disease, the spectacular advances made in the use and manipulation of autologous peripheral blood haemopoietic stem cells probably constitute the best hope for brightening the grim outlook most MDS patients still have.