Myelodysplastic syndromes

A heterogeneous group of acquired clonal bone marrow diseases has been captured under the term of myelodysplastic syndromes (MDS) that occur predominantly at higher age and are characterized by peripheral cytopenias despite normal or increased cellularity of the bone marrow. The slowly evolving process of neoplastic transformation explains the clinical, morphological and prognostic heterogeneity which is not sufficiently addressed even in current classification systems. In the last decade, considerable progress has been made in dissecting the pathobiology of these complex disorders. Therapeutic measures have to consider the prognosis of MDS as well as individual factors of the patient. Whereas the early stages are treated with supportive care, iron chelators, hematopoietic growth factors and immunomodulatory agents, more advanced cases require the use of demethylating agents and cytotoxic chemotherapy with or without stem cell support. Allogeneic stem cell transplantation remains the only curative option in MDS.