Key points
Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal stem cell disorders characterized by dysplasia, ineffective haematopoiesis, and potential risk of transformation into acute leukaemia.
In MDS, the important predictors for overall prognoses are cytogenetic abnormalities, percentage of myeloblasts in the bone marrow, and number of lineages that exhibit cytopenias.
Because the defect in MDS occurs in an early haematopoietic precursor, allogeneic transplant represents a potentially curative option.
References
1 1. Chudwin DS, Cowan MJ, Greenberg PL, Wara DW, Ammann AJ. Response of agranulocytosis to prolonged antithymocyte globulin therapy. J Pediatr. 1983; 103(2):223–227. doi:10.1016/s0022‐3476(83)80349‐7
2 2. Greenberg PL. The smoldering myeloid leukemic states: clinical and biologic features. Blood. 1983; 61(6):1035–1044.
3 3. Levine E.G. Bloomfield CD. Leukemias and myelodysplastic syndromes secondary to drug, radiation, and environmental exposure. Semin Oncol. 1992; 19(1):47–84.
4 4. Dahl G, Werner R, Levine E, Rabadan‐Diehl C. Mutational analysis of gap junction formation. Biophys J. 1992; 62(1):172–182. doi:10.1016/S0006‐3495(92)81803‐9
5 5. Germing U, Gattermann N, Minning H, Heyll A, Aul C. Problems in the classification of CMML‐‐dysplastic versus proliferative type. Leuk Res. 1998; 22(10):871–878. doi:10.1016/s0145‐2126(97)00192‐6
6 6. Greenberg P, Cox C, LeBeau MM, et al. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood. 1997; 89(6):2079–2088. doi:10.1182/blood.v89.6.2079
7 7. Malcovati L, Hellström‐Lindberg E, Bowen D, et al. Diagnosis and treatment of primary myelodysplastic syndromes in adults: Recommendations from the European LeukemiaNet. Blood. 2013; 122(17):2943–2964. doi:10.1182/blood‐2013‐03‐492884
8 8. Knickman JR, Snell EK. The 2030 problem: Caring for aging baby boomers. Health Serv Res. 2002; 37(4):849–884. doi:10.1034/j.1600‐0560.2002.56.x
9 9. Stauder R. The challenge of individualised risk assessment and therapy planning in elderly high‐risk myelodysplastic syndromes (MDS) patients. Ann Hematol. 2012; 91(9):1333–1343. doi:10.1007/s00277‐012‐1472‐8
10 10. Aul C, Gattermann N. The role of low‐dose chemotherapy in myelodysplastic syndromes. Leuk Res. 1992; 16(3):207–215. doi:10.1016/0145‐2126(92)90058‐f
11 11. Ma X, Does M, Raza A, Mayne ST. Myelodysplastic syndromes: Incidence and survival in the United States. Cancer. 2007; 109(8):1536–1542. doi:10.1002/cncr.22570
12 12. Rollison DE, Howlader N, Smith MT, et al. Epidemiology of myelodysplastic syndromes and chronic myeloproliferative disorders in the United States, 2001‐2004, using data from the NAACCR and SEER programs. Blood. 2008; 112(1):45–52. doi:10.1182/blood‐2008‐01‐134858
13 13. Cogle CR, Craig BM, Rollison DE, List AF. Incidence of the myelodysplastic syndromes using a novel claims‐based algorithm: High number of uncaptured cases by cancer registries. Blood. 2011; 117(26):7121–7125. doi:10.1182/blood‐2011‐02‐337964
14 14. Goldberg SL, Chen E, Corral M, et al. Incidence and clinical complications of myelodysplastic syndromes among United States Medicare beneficiaries. J Clin Oncol. 2010; 28(17):2847–2852. doi:10.1200/JCO.2009.25.2395
15 15. Pedersen‐Bjergaard J, Philip P. Balanced translocations involving chromosome bands 11q23 and 21q22 are highly characteristic of myelodysplasia and leukemia following therapy with cytostatic agents targeting at DNA‐topoisomerase II. Blood. 1991; 78(4):1147–1148.
16 16. Pomeroy C, Oken MM, Rydell RE, Filice GA. Infection in the myelodysplastic syndromes. Am J Med. 1991; 90(1):338–344. doi:10.1016/0002‐9343(91)90574‐H
17 17. Boogaerts MA, Nelissen V, Roelant C, Goossens W. Blood neutrophil function in primary myelodysplastic syndromes. Br J Haematol. 1983; 55(2):217–227. doi:10.1111/j.1365‐2141.1983.tb01241.x
18 18. Greenberg PL, Tuechler H, Schanz J, et al. Revised international prognostic scoring system for myelodysplastic syndromes. Blood. 2012; 120(12):2454–2465. doi:10.1182/blood‐2012‐03‐420489
19 19. della Porta MG, Malcovati L, Strupp C, et al. Risk stratification based on both disease status and extra‐hematologic comorbidities in patients with myelodysplastic syndrome. Haematologica. 2011; 96(3):441–449. doi:10.3324/haematol.2010.033506
20 20. Naqvi K, Garcia‐Manero G, Sardesai S, et al. Association of comorbidities with overall survival in myelodysplastic syndrome: Development of a prognostic model. J Clin Oncol. 2011; 29(16):2240–2246. doi:10.1200/JCO.2010.31.3353
21 21. Van Spronsen MF, Ossenkoppele GJ, Holman R, Van De Loosdrecht AA. Improved risk stratification by the integration of the revised International Prognostic Scoring System with the Myelodysplastic Syndromes Comorbidity Index. Eur J Cancer. 2014; 50(18):3198–3205. doi:10.1016/j.ejca.2014.09.016
22 22. Daver N, Naqvi K, Jabbour E, et al. Impact of comorbidities by ACE‐27 in the revised‐IPSS for patients with myelodysplastic syndromes. Am J Hematol. 2014; 89(5):509–516. doi:10.1002/ajh.23675
23 23. Balleari E, Salvetti C, Del Corso L, et al. Age and comorbidities deeply impact on clinical outcome of patients with myelodysplastic syndromes. Leuk Res. 2015; 39(8):846–852. doi:10.1016/j.leukres.2015.05.007
24 24. Hurria A, Mohile S, Gajra A, et al. Validation of a Prediction Tool for Chemotherapy Toxicity in Older Adults With Cancer. J Clin Oncol. 2016; 34(20). doi:10.1200/JCO.2015.65.4327
25 25. Van Der Walde N, Jagsi R, Dotan E, et al. Older adult oncology, version 2.2016: Featured updates to the NCCN guidelines. JNCCN J Natl Compr Cancer Netw. 2016; 14(11):1357–1370. doi:10.6004/jnccn.2016.0146
26 26. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004; 59(3):255–263. doi:10.1093/gerona/59.3.m255
27 27. Hamaker ME, Schiphorst AH, ten Bokkel Huinink D, Schaar C, van Munster BC. The effect of a geriatric evaluation on treatment decisions for older cancer patients – a systematic review. Acta Oncol (Madr). 2014; 53(3):289–296. doi:10.3109/0284186X.2013.840741
28 28. Cohen HJ, Smith D, Sun CL, et al. Frailty as determined by a comprehensive geriatric assessment‐derived deficit‐accumulation index in older patients with cancer who receive chemotherapy. Cancer. 2016; 122(24):3865–3872. doi:10.1002/cncr.30269
29 29. Guerard EJ, Deal AM, Chang Y, et al. Frailty index developed from a cancer‐specific geriatric assessment and the association with mortality among older adults with cancer. JNCCN J Natl Compr Cancer Netw. 2017; 15(7):894–902. doi:10.6004/jnccn.2017.0122
30 30. Mohile SG, Dale W, Somerfield MR, et al. Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: Asco guideline for geriatric oncology. J Clin Oncol. 2018; 36(22):2326–2347. doi:10.1200/JCO.2018.78.8687
31 31. Abel GA, Hshieh TT, Condron NB, et al. Feasibility of Routine Frailty Screening Assessment for Patients in a Hematologic Oncology Clinic: Results from a Pilot
