[Intensive chemotherapy in myelodysplastic syndromes]

Intensive AML-like chemotherapy with anthracycline and cytosine-arabinoside or similar combinations gives lower CR rates and CR durations when administered to patients with severe MDS or AML evolving from prior MDS than to these with de novo AML. However such intensive therapies could be beneficial to younger patients without unfavorable cytogenicity when they don't have an available donor for allogeneic transplant. Numerous studies with high dose cytosine, arabinoside, idavudicine, fludarabine drugs that reverse mdr expression, or granulocytic growth factors have been conducted or are still ongoing in order to try to improve these results. In patients achieving a complete remission, intensification with autologous transplantation has also to be evaluated.