Wiener Klinische Wochenschrift

, Volume 115, Issue 13–14, pp 515–536

Pathogenesis, classification, and treatment of myelodysplastic syndromes (MDS)

  • Peter Valent
  • Friedrich Wimazal
  • Ilse Schwarzinger
  • Wolfgang R. Sperr
  • Klaus Geissler
Review Article

Summary

Myelodysplastic syndromes (MDS) comprise a heterogeneous group of clonal myeloid disorders characterized by morphologic dysplasia in one or more cell lineages. Dysplasia in MDS is associated with insufficient production of blood cells and consecutive cytopenia(s). The natural course and prognosis of MDS vary among patients and depend on genetic defects that occur during clonal evolution. In a significant group of patients (roughly 30%) progression to secondary leukemia is observed. These patients appear to have a grave prognosis. The treatment of patients with MDS has to be adjusted to the individual situation and age in each case. In many patients, control of blast cell production by palliative cytoreduction, continuous support with red blood cells, as well as other supportive measures, seem appropriate. In other patients, however, curative therapy (chemotherapy, stem cell transplantation) should be considered. The final decision to offer curative therapy must be based on many different factors including age and the overall situation of the patient. Recently established scoring systems aimed at predicting survival and evolution of leukemia in MDS may be helpful in this regard.

Key words

Preleukemic syndromes secondary leukemia FAB IPSS WHO chemotherapy targeted therapy cytokine therapy 

Pathogenese, Klassifikation und Therapie der myelodysplastischen Syndrome

Zusammenfassung

Myelodysplastische Syndrome (MDS) umfassen eine heterogene Gruppe von klonalen myeloischen Erkrankungen, welche durch dysplastische Veränderungen in einer oder mehreren Zellreihen gekennzeichnet sind. Die Dysplasie im MDS ist mit einer insuffizienten Blutproduktion und konsekutiver Zytopenie(n) assoziiert. Der Verlauf und die Prognose des MDS richten sich nach den genetischen Defekten, welche im Laufe der klonalen Evolution entstehen. In einem signifikanten Teil der Patienten (cirka 30%) entwickeln sich sekundäre Leukämien. Diese Patienten weisen eine reduzierte Prognose auf. Die Therapie des MDS sollte dem Alter und der individuellen Situation des Patienten angepasst werden. In vielen Fällen handelt es sich dabei um eine palliative zytoreduktive Therapie und/oder Erythrozytenersatz, sowie andere supportive Maßnahmen. Für einen Teil der Patienten kommen aber auch kurative Therapieansätze (Chemotherapie, Stammzelltransplantation) in Betracht. Die endgültige Entscheidung sollte dabei immer von mehreren Faktoren abhängig gemacht werden, wobei die individuelle Situation des Patienten und sein Alter eine wichtige Rolle spielen. Scoring-Systeme zur Abschätzung der Prognose des MDS können dabei oft eine zusätzliche Entscheidungshilfe bieten.

Schlüsselwörter

Preleukämie Sekundäre Leukämie FAB IPSS WHO Chemotherapy Targeted Therapy Zytokintherapie 

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Copyright information

© Springer 2003

Authors and Affiliations

  • Peter Valent
    • 3
  • Friedrich Wimazal
    • 3
  • Ilse Schwarzinger
    • 1
  • Wolfgang R. Sperr
    • 3
  • Klaus Geissler
    • 2
  1. 1.Institute of Medical and Chemical Laboratory DiagnosticsUniversity of ViennaViennaAustria
  2. 2.Fifth Medical Department-OncologyHospital LainzViennaAustria
  3. 3.Department of Internal, Medicine I, Division of HematologyUniversity of ViennaViennaAustria

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