Abstract
The myelodysplastic syndromes (MDS) are a group of heterogeneous myeloid stem-cell malignancies most prevalent in the seventh and eighth decades of life. Since most patients are elderly, are treated as outpatients, and often have comorbidities, management of MDS presents challenges to oncology practitioners. Allogeneic hematopoietic stem-cell transplantation is the only potential cure for MDS, but it is not an option for most patients based on age and comorbidities. Three agents (azacitadine, decitabine, and lenalidomide) have recently been approved for treatment of MDS, and treatment guidelines continue to evolve. Selection and goals of treatment are based on International Prognostic Scoring System risk category, other disease-specific factors, and patient characteristics, such as comorbidities and performance status. Recent data showing survival benefit for azacitadine have led to a shift in the goals of treatment from symptomatic improvement to increased overall survival. With all active therapies, however, treatment response requires several months, and patient education and supportive care are needed to allow the patient to continue treatment long enough to realize benefits. Myelosuppression is the most common toxicity with all active therapies, and it may get worse before improvement is seen. Advanced practitioners can help set patient and family expectations and educate them about clinical management strategies to reduce the frequency and severity of adverse effects.
