New aspects of the treatment of patients with low-risk myelodysplastic syndromes

Myelodysplastic syndromes (MDS) are characterized initially by ineffective hematopoiesis and subsequently the frequent development of acute myelogenou s leukemias (AML). During the last 15 years, important progress has been ma de in the understanding of the biology and prognosis of MDS. Risk-adapted t reatment strategies were established due to the high median age (60-75 year s) of MDS patients and the individual history of the disease (number of cyt openias, cytogenetical changes, transfusion requirements), The use of allog eneic bone marrow transplantation for MDS patients currently offers the onl y potentially curative treatment, but this treatment modality is not availa ble for most of the 'typical' MDS patients aged >60 years. Based on in-vitr o findings analyzing the potential of several agents to differentiate or to stimulate hematopoietic progenitor cells, a number of therapeutic options were evaluated in clinical trials: hematopoietic growth factors (e.g. eryth ropoietin, granulocyte colony-stimulating factor), differentiation inducers (e.g, retinoids), or cytoprotective substances (amifostine), The role of i mmunsuppressive agents (antithymocyte globulin, cyclosporin A) either alone or in combination is being investigated actively.