Myelodysplastic syndromes: An emerging hematologic pathology in the elderly

G. Lambertenghi Deliliers, C. Annaloro, D. Lambertenghi Deliliers

Research output: Contribution to journalArticlepeer-review

Abstract

Myelodysplastic syndromes (MDS) are clonal diseases of hemopoietic stem cells that prevalently affect patients aged more than 60 years and are more common among males. However, the incidence of MDS is constantly increasing among young subjects who have undergone antineo-plastic or immunodepressant therapies, in which case they are called secondary MDS. The FAB classification, which is based on the examination of peripheral blood and bone marrow aspirates still retains a good part of its validity despite the recent identification of other clinico-pathological entities. MDS are mainly diagnosed in patients presenting clinical manifestations relating to anemia, neutropenia or more rarely thrombocytopenia, but they are being increasingly diagnosed in the absence of symptoms on the basis of the results of periodic laboratory control tests. In addition to bone marrow aspirate and peripheral blood examinations, cytogenetic analyses and bone marrow biopsies are important complements. The clinical course of MDS varies, but life expectancy is between one and four years in most cases. About one-third of the cases of MDS undergo leukemic transformation, but the most frequent lethal complication is their evolution towards bone marrow failure. At univariate analysis, many clinical and laboratory parameters have been found to be prognostically relevant, but only the definition of multifactorial scores makes it possible to identify patients at different levels of risk and therefore adjust the therapy to the prognosis. MDS can be treated with support therapy alone, which has the aim of attenuating the symptoms and controlling complications especially in more elderly patients with a relatively favourable prognosis. In young patients and those with aggressive disease, attempts are made to eradicate the disease by means of allogeneic stem cell transplantation or, in the absence of an HLA-compatible donor, aggressive polychemotherapeutic regimens similar to those used to treat acute myeloid leukemia. Other recently proposed therapeutic strategies that are still under evaluation have the aim of modifying the natural history of the disease and improving the patients' quality of life.

Original languageEnglish
Pages (from-to)7-17
Number of pages11
JournalGeriatric and Medical Intelligence
Volume11
Issue number1
Publication statusPublished - 2002

Keywords

  • Elderly
  • Hematology
  • Myelodysplasia

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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