How I treat How I treat patients with myelodysplastic syndromes

Critical issues in determining therapeutic strategies for patients with myelodysplastic syndromes (MDSs), who usually die of bone marrow failure with or without conversion to acute myeloid leukemia (AML), include host factors in these mainly older patients, disease heterogeneity, lack of pathogenetic understanding, and a dearth of effective treatments. Even the issue of whether these clonal disorders should be considered a form of cancer represents an area of controversy.1 Nonetheless, in the past several years, 4 new drugs (5-azacitidine, decitabine, deferasirox, and lenalidomide) have been approved by the Food and Drug Administration (FDA) for use in MDS. Once the diagnosis and prognosis are established, key decisions in the approach to a patient with MDS include when to initiate treatment, establishment of an optimum supportive strategy, and choosing among available therapies, especially a potentially curative allogeneic stem cell transplantation.