Affiliation:
1. University of Belgrade, Faculty of Pharmacy, Belgrade
2. Clinical Center of Vojvodina, Clinic of Hematology + University of Novi Sad, Faculty of Medicine Novi Sad
3. University Clinical Center of Serbia, Clinic of Hematology + University of Belgrade, Faculty of Medicine, Belgrade
Abstract
Introduction. We present the recommendations for treatment of the lower-risk
myelodysplastic syndromes on behalf of the Serbian myelodysplastic syndromes
group. Material and Methods. A literature review was conducted using the
following bibliographic databases: Google Scholar, MEDLINE and Kobson. The
recommendations for treatment of lower-risk myelodysplastic syndromes are
based on expert opinion based on review of the literature and contemporary
recommendations for treatment of lower risk myelodysplastic syndromes.
Recommendations. Anemia is the most relevant cytopenia in terms of frequency
and symptoms in lower-risk myelodysplastic syndromes, and may be treated
successfully with erythropoietic stimulating agents, with or without
granulocyte growth factor, provided a careful selection is performed on the
basis of Revised International Prognostic Scoring System, endogenous
erythropoietin levels, and transfusion independence. In case a patient fails
erythropoietic stimulating agents treatment, the available options may
include lenalidomide, hypomethylating agents, and a rather large number of
experimental agents. Chelation therapy is recommended in patients who have
received or are anticipated to receive > 20 red blood cell transfusions and
those with serum ferritin levels > 2500 ng/mL. Specific therapy for
thrombocytopenia has been proposed in experimental clinical trials with
thrombomimetic agents that have shown good efficacy, but raised some safety
concern. Severe neutropenia is targeted symptomatically with growth factor
supportive care. The immunosuppressive treatments are indicated mainly for
pancytopenia, hypoplastic lowerrisk myelodysplastic syndromes. Finally,
hematopoietic stem cell transplantation is the curative option for younger,
good performance (fit) lower-risk patient with poor risk features, according
to European Blood and Marrow Transplantation/European Leukemia Net
International expert panel and myelodysplastic syndrome-RIGHT group.
Conclusion. Treatment of myelodysplastic syndromes is mainly based on
resolution of symptoms due to particular cytopenia(s).
Publisher
National Library of Serbia
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