Overview The myelodysplastic syndromes (MDS) represent myeloid clonal hemopathies with relatively heterogeneous spectrums of presentation. The major clinical problems in these disorders are morbidities caused by cytopenias and the potential for MDS to evolve into acute myeloid leukemia (AML). In the general population, MDS occur in 5 per 100,000 people. However, among individuals older than 70 years, the incidence increases to between 22 and 45 per 100,000 and increases further with age. Managing MDS is complicated by the generally advanced age of the patients (median ages, 65–70 years), attendant nonhematologic comorbidities, and relative inability to tolerate certain intensive forms of therapy among older patients. In addition, when the illness progresses to AML, these patients experience lower response rates to standard therapy than those with de novo AML.1 Diagnostic Classification Initial evaluation of patients with suspected MDS requires careful assessment of their peripheral blood smear and blood counts, marrow morphology, duration of their abnormal blood counts, other potential causes for their cytopenias, and concomitant illnesses. The French-American-British (FAB) classification initially categorized patients for the diagnostic evaluation of MDS.2 Dysplastic changes in at least 2 of the 3 hematopoietic cell lines have been used by most histopathologists to diagnose MDS. These changes include megaloblastoid erythropoiesis, nucleocytoplasmic asynchrony in the early myeloid and erythroid precursors, and dysmorphic megakaryocytes.3 Patients with MDS are classified as having 1 of 5 subtypes of disease: refractory anemia (RA); RA with ringed sideroblasts (RARS); RA with excess of blasts (RAEB); RAEB in transformation (RAEB-T); or chronic myelomonocytic leukemia...
  • 1.

    GreenbergP. The myelodysplastic syndromes. In: HoffmanRBenzEShattilS. eds. Hematology: Basic Principles and Practice 3rd ed.New York, NY: Churchill Livingstone; 2000:11061129.

    • Search Google Scholar
    • Export Citation
  • 2.

    BennettJMCatovskyDDanielMT. Proposals for the classification of the myelodysplastic syndromes. Br J Haematol1982;51:189199.

  • 3.

    KouidesPABennettJM. Morphology and classification of the myelodysplastic syndromes and their pathologic variants. Semin Hematol1996;33:95110.

    • Search Google Scholar
    • Export Citation
  • 4.

    BrunningRBennettJFlandrinG. Myelodysplastic syndromes. In: JaffeEHarrisNSteinH. eds. WHO Classification of Tumours. Pathology and Genetics of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press; 2001:6173.

    • Search Google Scholar
    • Export Citation
  • 5.

    HarrisNLJaffeESDieboldJ. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Clin Oncol1999;17:38353849.

    • Search Google Scholar
    • Export Citation
  • 6.

    VardimanJWHarrisNLBrunningRD. The World Health Organization (WHO) classification of the myeloid neoplasms. Blood2002;100:22922302.

  • 7.

    KaloutsiVKohlmeyerUMaschekH. Comparison of bone marrow and hematologic findings in patients with human immunodeficiency virus infection and those with myelodysplastic syndromes and infectious diseases. Am J Clin Pathol1994;101:123129.

    • Search Google Scholar
    • Export Citation
  • 8.

    SwerdlowSCampoEHarrisNL. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press; 2008:88103.

    • Search Google Scholar
    • Export Citation
  • 9.

    BrunningROraziAGermingU. Myelodysplastic syndromes/neoplasms. In: SwerdlowSHCampoEHarrisNL. eds. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues 4th ed.Lyon, France: IARC Press; 2008:88103.

    • Search Google Scholar
    • Export Citation
  • 10.

    VardimanJWThieleJArberDA. The 2008 revision of the WHO classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood2009;114:937951.

    • Search Google Scholar
    • Export Citation
  • 11.

    GreenbergPCoxCLeBeauMM. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood1997;89:20792088. Erratum in: Blood 1998;2091:1100.

    • Search Google Scholar
    • Export Citation
  • 12.

    ListADewaldGBennettJ. Lenalidomide in the myelodysplastic syndrome with chromosome 5q deletion. N Engl J Med2006;355:14561465.

  • 13.

    Orazi ABJGermingU. eds. Myelodysplastic/myeloproliferative neoplasms. In: SwerdlowSHCampoEHarrisNL. eds. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues 4th ed.Lyon, France: IARC Press; 2008:7686.

    • Search Google Scholar
    • Export Citation
  • 14.

    AlbitarMManshouriTShenY. Myelodysplastic syndrome is not merely ``preleukemia''. Blood2002;100:791798.

  • 15.

    GreenbergPAndersonJde WitteT. Problematic WHO reclassification of myelodysplastic syndromes. Members of the International MDS Study Group. J Clin Oncol2000;18:34473452.

    • Search Google Scholar
    • Export Citation
  • 16.

    GermingUGattermannNStruppC. Validation of the WHO proposals for a new classification of primary myelodysplastic syndromes: a retrospective analysis of 1600 patients. Leuk Res2000;24:983992.

    • Search Google Scholar
    • Export Citation
  • 17.

    NosslingerTReisnerRKollerE. Myelodysplastic syndromes, from French-American-British to World Health Organization: comparison of classifications on 431 unselected patients from a single institution. Blood2001;98:29352941.

    • Search Google Scholar
    • Export Citation
  • 18.

    ArberDPorwitABrunningRD. Acute myeloid leukaemia with myelodysplasia-related changes. In: JaffeESHarrisNLSteinHVardimanJW eds. Acute Myeloid Leukemia and Related Precursor Neoplasms. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues 4th ed.Lyon, France: IARC Press; 2008:124126.

    • Search Google Scholar
    • Export Citation
  • 19.

    ValentPHornyHPBennettJM. Definitions and standards in the diagnosis and treatment of the myelodysplastic syndromes: consensus statements and report from a working conference. Leuk Res2007;31:727736.

    • Search Google Scholar
    • Export Citation
  • 20.

    DunnDETanawattanacharoenPBoccuniP. Paroxysmal nocturnal hemoglobinuria cells in patients with bone marrow failure syndromes. Ann Intern Med1999;131:401408.

    • Search Google Scholar
    • Export Citation
  • 21.

    SaunthararajahYNakamuraRNamJM. HLA-DR15 (DR2) is overrepresented in myelodysplastic syndrome and aplastic anemia and predicts a response to immunosuppression in myelodysplastic syndrome. Blood2002;100:15701574.

    • Search Google Scholar
    • Export Citation
  • 22.

    BaxterEJKulkarniSVizmanosJL. Novel translocations that disrupt the platelet-derived growth factor receptor beta (PDGFRB) gene in BCR-ABL-negative chronic myeloproliferative disorders. Br J Haematol2003;120:251256.

    • Search Google Scholar
    • Export Citation
  • 23.

    SteerEJCrossNC. Myeloproliferative disorders with translocations of chromosome 5q31-35: role of the platelet-derived growth factor receptor Beta. Acta Haematol2002;107:113122.

    • Search Google Scholar
    • Export Citation
  • 24.

    ApperleyJFGardembasMMeloJV. Response to imatinib mesylate in patients with chronic myeloproliferative diseases with rearrangements of the platelet-derived growth factor receptor beta. N Engl J Med2002;347:481487.

    • Search Google Scholar
    • Export Citation
  • 25.

    MagnussonMKMeadeKENakamuraR. Activity of STI571 in chronic myelomonocytic leukemia with a platelet-derived growth factor beta receptor fusion oncogene. Blood2002;100:10881091.

    • Search Google Scholar
    • Export Citation
  • 26.

    SteensmaDPDewaldGWLashoTL. The JAK2 V617F activating tyrosine kinase mutation is an infrequent event in both ``atypical'' myeloproliferative disorders and myelodysplastic syndromes. Blood2005;106:12071209.

    • Search Google Scholar
    • Export Citation
  • 27.

    SzpurkaHTiuRMurugesanG. Refractory anemia with ringed sideroblasts associated with marked thrombocytosis (RARS-T), another myeloproliferative condition characterized by JAK2 V617F mutation. Blood2006;108:21732181.

    • Search Google Scholar
    • Export Citation
  • 28.

    OgataKNakamuraKYokoseN. Clinical significance of phenotypic features of blasts in patients with myelodysplastic syndrome. Blood2002;100:38873896.

    • Search Google Scholar
    • Export Citation
  • 29.

    WellsDABeneschMLokenMR. Myeloid and monocytic dyspoiesis as determined by flow cytometric scoring in myelodysplastic syndrome correlates with the IPSS and with outcome after hematopoietic stem cell transplantation. Blood2003;102:394403.

    • Search Google Scholar
    • Export Citation
  • 30.

    GreggXTReddyVPrchalJT. Copper deficiency masquerading as myelodysplastic syndrome. Blood2002;100:14931495.

  • 31.

    HaddadASSubbiahVLichtinAE. Hypocupremia and bone marrow failure. Haematologica2008;93:e15.

  • 32.

    KocaEBuyukasikYCetinerD. Copper deficiency with increased hematogones mimicking refractory anemia with excess blasts. Leuk Res2008;32:495499.

    • Search Google Scholar
    • Export Citation
  • 33.

    ProdanCIBottomleySSVincentAS. Hypocupremia associated with prior vitamin B12 deficiency. Am J Hematol2007;82:288290.

  • 34.

    SanzGFSanzMAGreenbergPL. Prognostic factors and scoring systems in myelodysplastic syndromes. Haematologica1998;83:358368.

  • 35.

    BennettJMCatovskyDDanielMT. The chronic myeloid leukaemias: guidelines for distinguishing chronic granulocytic, atypical chronic myeloid, and chronic myelomonocytic leukaemia. Proposals by the French-American-British Cooperative Leukaemia Group. Br J Haematol1994;87:746754.

    • Search Google Scholar
    • Export Citation
  • 36.

    MalcovatiLPortaMGPascuttoC. Prognostic factors and life expectancy in myelodysplastic syndromes classified according to WHO criteria: a basis for clinical decision making. J Clin Oncol2005;23:75947603.

    • Search Google Scholar
    • Export Citation
  • 37.

    KaoJMMcMillanAGreenbergPL. International MDS risk analysis workshop (IMRAW)/IPSS reanalyzed: impact of cytopenias on clinical outcomes in myelodysplastic syndromes. Am J Hematol2008;83:765770.

    • Search Google Scholar
    • Export Citation
  • 38.

    AlessandrinoEPDella PortaMGBacigalupoA. WHO classification and WPSS predict posttransplantation outcome in patients with myelodysplastic syndrome: a study from the Gruppo Italiano Trapianto di Midollo Osseo (GITMO). Blood2008;112:895902.

    • Search Google Scholar
    • Export Citation
  • 39.

    CermakJKacirkovaPMikulenkovaDMichalovaK. Impact of transfusion dependency on survival in patients with early myelodysplastic syndrome without excess of blasts. Leuk Res2009;33:14691474.

    • Search Google Scholar
    • Export Citation
  • 40.

    MalcovatiLGermingUKuendgenA. Time-dependent prognostic scoring system for predicting survival and leukemic evolution in myelodysplastic syndromes. J Clin Oncol2007;25:35033510.

    • Search Google Scholar
    • Export Citation
  • 41.

    ParkMJKimHJKimSH. Is International Prognostic Scoring System (IPSS) still standard in predicting prognosis in patients with myelodysplastic syndrome? External validation of the WHO Classification-Based Prognostic Scoring System (WPSS) and comparison with IPSS. Eur J Haematol2008;81:364373.

    • Search Google Scholar
    • Export Citation
  • 42.

    ChesonBDBennettJMKantarjianH. Report of an international working group to standardize response criteria for myelodysplastic syndromes. Blood2000;96:36713674.

    • Search Google Scholar
    • Export Citation
  • 43.

    GreenbergPBaerMBennettJ. NCCN Myelodysplastic Syndromes Guidelines. NCCN Clinical Practice Guidelines in Oncology [Version 1 2001 CD-ROM]. Rockledge, PA: National Comprehensive Cancer Network2001. To view the most recent version of the guideline go to www.NCCN.org.

    • Search Google Scholar
    • Export Citation
  • 44.

    GreenbergP. The role of hemopoietic growth factors in the treatment of myelodysplastic syndromes. Int J Pediatr Hematol Oncol1997;4:231238.

    • Search Google Scholar
    • Export Citation
  • 45.

    GreenbergPL. Myelodysplastic syndromes: iron overload consequences and current chelating therapies. J Natl Compr Canc Netw2006;4:9196.

    • Search Google Scholar
    • Export Citation
  • 46.

    FarquharMJBowenDT. Oxidative stress and the myelodysplastic syndromes. Int J Hematol2003;77:342350.

  • 47.

    HershkoCLinkGCabantchikI. Pathophysiology of iron overload. Ann N Y Acad Sci1998;850:191201.

  • 48.

    JaegerMAulCSohngenD. [Secondary hemochromatosis in polytransfused patients with myelodysplastic syndromes.]Beitr Infusionsther1992;30:464468 [in German].

    • Search Google Scholar
    • Export Citation
  • 49.

    SchaferAICheronRGDluhyR. Clinical consequences of acquired transfusional iron overload in adults. N Engl J Med1981;304:319324.

  • 50.

    MalcovatiL. Impact of transfusion dependency and secondary iron overload on the survival of patients with myelodysplastic syndromes. Leuk Res2007;31(Suppl 3):S26.

    • Search Google Scholar
    • Export Citation
  • 51.

    BrittenhamGMBadmanDG. Noninvasive measurement of iron: report of an NIDDK workshop. Blood2003;101:1519.

  • 52.

    St PierreTGClarkPRChua-anusornW. Noninvasive measurement and imaging of liver iron concentrations using proton magnetic resonance. Blood2005;105:855861.

    • Search Google Scholar
    • Export Citation
  • 53.

    JensenPDHeickendorffLPedersenB. The effect of iron chelation on haemopoiesis in MDS patients with transfusional iron overload. Br J Haematol1996;94:288299.

    • Search Google Scholar
    • Export Citation
  • 54.

    JensenPDJensenFTChristensenT. Evaluation of myocardial iron by magnetic resonance imaging during iron chelation therapy with deferrioxamine: indication of close relation between myocardial iron content and chelatable iron pool. Blood2003;101:46324639.

    • Search Google Scholar
    • Export Citation
  • 55.

    CohenARGalanelloRPigaA. Safety and effectiveness of long-term therapy with the oral iron chelator deferiprone. Blood2003;102:15831587.

    • Search Google Scholar
    • Export Citation
  • 56.

    Nisbet-BrownEOlivieriNFGiardinaPJ. Effectiveness and safety of ICL670 in iron-loaded patients with thalassaemia: a randomised, double-blind, placebo-controlled, dose-escalation trial. Lancet2003;361:15971602.

    • Search Google Scholar
    • Export Citation
  • 57.

    PigaAGalanelloRCappelliniMD. Phase II study of ICL670, an oral chelator, in adult thalassaemia patients with transfusional iron overload: efficacy, safety, pharmaco kinetics (PK) and pharmacodynamics (PD) after 18 months of therapy [abstract]. Blood2003;102:Abstract 412.

    • Search Google Scholar
    • Export Citation
  • 58.

    OlivieriNFKorenGHermannC. Comparison of oral iron chelator L1 and desferrioxamine in iron-loaded patients. Lancet1990;336:12751279.

  • 59.

    GreenbergPRigsbyCKStoneRM. NCCN Task Force Report: transfusion and iron overload in patients with myelodysplastic syndromes. Available at: http://www.nccn.org/JNCCN/PDF/2009_Transfussion_MDS_TF.pdf. Accessed November 22 2010.

    • Search Google Scholar
    • Export Citation
  • 60.

    KantarjianHIssaJPRosenfeldCS. Decitabine improves patient outcomes in myelodysplastic syndromes: results of a phase III randomized study. Cancer2006;106:17941803.

    • Search Google Scholar
    • Export Citation
  • 61.

    SilvermanLRDemakosEPPetersonBL. Randomized controlled trial of azacitidine in patients with the myelodysplastic syndrome: a study of the cancer and leukemia group B. J Clin Oncol2002;20:24292440.

    • Search Google Scholar
    • Export Citation
  • 62.

    SilvermanLRMcKenzieDRPetersonBL. Further analysis of trials with azacitidine in patients with myelodysplastic syndrome: studies 8421, 8921, and 9221 by the Cancer and Leukemia Group B. J Clin Oncol2006;24:38953903.

    • Search Google Scholar
    • Export Citation
  • 63.

    FenauxPMuftiGJHellstrom-LindbergE. Efficacy of azacitidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: a randomised, open-label, phase III study. Lancet Oncol2009;10:223232.

    • Search Google Scholar
    • Export Citation
  • 64.

    LubbertMWijermansPKunzmannR. Cytogenetic responses in high-risk myelodysplastic syndrome following low-dose treatment with the DNA methylation inhibitor 5-aza-2'-deoxycytidine. Br J Haematol2001;114:349357.

    • Search Google Scholar
    • Export Citation
  • 65.

    WijermansPLubbertMVerhoefG. Low-dose 5-aza-2'-deoxycytidine, a DNA hypomethylating agent, for the treatment of high-risk myelodysplastic syndrome: a multicenter phase II study in elderly patients. J Clin Oncol2000;18:956962.

    • Search Google Scholar
    • Export Citation
  • 66.

    SabaHRosenfeldCIssaJP. First report of the phase III north American trial of decitabine in advanced myelodysplastic syndrome (MDS) [abstract]. Blood2004;104:Abstract 67.

    • Search Google Scholar
    • Export Citation
  • 67.

    van den BoschJLubbertMVerhoefGWijermansPW. The effects of 5-aza-2'-deoxycytidine (Decitabine) on the platelet count in patients with intermediate and high-risk myelodysplastic syndromes. Leuk Res2004;28:785790.

    • Search Google Scholar
    • Export Citation
  • 68.

    SabaHILubbertMWijermansPW. Response rates of phase 2 and phase 3 trials of decitabine (DAC) in patients with myelodysplastic syndromes (MDS) [abstract]. Blood2005;106:Abstract 2515.

    • Search Google Scholar
    • Export Citation
  • 69.

    KantarjianHO'BrienSGilesF. Decitabine low-dose schedule (100 mg/m2/Course) in myelodysplastic syndrome (MDS). Comparison of 3 different dose schedules [abstract]. Blood2005;106:Asbtract 2522.

    • Search Google Scholar
    • Export Citation
  • 70.

    KantarjianHMO'BrienSShanJ. Update of the decitabine experience in higher risk myelodysplastic syndrome and analysis of prognostic factors associated with outcome. Cancer2007;109:265273.

    • Search Google Scholar
    • Export Citation
  • 71.

    KantarjianHOkiYGarcia-ManeroG. Results of a randomized study of 3 schedules of low-dose decitabine in higher-risk myelodysplastic syndrome and chronic myelomonocytic leukemia. Blood2007;109:5257.

    • Search Google Scholar
    • Export Citation
  • 72.

    DeegHJGotlibJBeckhamC. Soluble TNF receptor fusion protein (etanercept) for the treatment of myelodysplastic syndrome: a pilot study. Leukemia2002;16:162164.

    • Search Google Scholar
    • Export Citation
  • 73.

    DeegHJJiangPYHolmbergLA. Hematologic responses of patients with MDS to antithymocyte globulin plus etanercept correlate with improved flow scores of marrow cells. Leuk Res2004;28:11771180.

    • Search Google Scholar
    • Export Citation
  • 74.

    JonásováANeuwirtováRCermákJ. 164 Promising cyclosporin a therapy for myelodysplastic syndrome. Leuk Res1997;21:S5353.

  • 75.

    MolldremJJCaplesMMavroudisD. Antithymocyte globulin for patients with myelodysplastic syndrome. Br J Haematol1997;99:699705.

  • 76.

    RazaAMeyerPDuttD. Thalidomide produces transfusion independence in long-standing refractory anemias of patients with myelodysplastic syndromes. Blood2001;98:958965.

    • Search Google Scholar
    • Export Citation
  • 77.

    StruppCGermingUAivadoM. Thalidomide for the treatment of patients with myelodysplastic syndromes. Leukemia2002;16:16.

  • 78.

    SloandEMWuCOGreenbergP. Factors affecting response and survival in patients with myelodysplasia treated with immunosuppressive therapy. J Clin Oncol2008;26:25052511.

    • Search Google Scholar
    • Export Citation
  • 79.

    ListAKurtinSRoeDJ. Efficacy of lenalidomide in myelodysplastic syndromes. N Engl J Med2005;352:549557.

  • 80.

    NimerSD. Clinical management of myelodysplastic syndromes with interstitial deletion of chromosome 5q. J Clin Oncol2006;24:25762582.

    • Search Google Scholar
    • Export Citation
  • 81.

    RazaAReevesJAFeldmanEJ. Phase 2 study of lenalidomide in transfusion-dependent, low-risk, and intermediate-1 risk myelodysplastic syndromes with karyotypes other than deletion 5q. Blood2008;111:86–-93.

    • Search Google Scholar
    • Export Citation
  • 82.

    TricotGBoogaertsMA. The role of aggressive chemotherapy in the treatment of the myelodysplastic syndromes. Br J Haematol1986;63:477483.

    • Search Google Scholar
    • Export Citation
  • 83.

    EsteyEHThallPFCortesJE. Comparison of idarubicin + ara-C-, fludarabine + ara-C-, and topotecan + ara-C-based regimens in treatment of newly diagnosed acute myeloid leukemia, refractory anemia with excess blasts in transformation, or refractory anemia with excess blasts. Blood2001;98:35753583.

    • Search Google Scholar
    • Export Citation
  • 84.

    SonneveldPvan DongenJJHagemeijerA. High expression of the multidrug resistance P-glycoprotein in high-risk myelodysplasia is associated with immature phenotype. Leukemia1993;7:963969.

    • Search Google Scholar
    • Export Citation
  • 85.

    AdvaniRSabaHITallmanMS. Treatment of refractory and relapsed acute myelogenous leukemia with combination chemotherapy plus the multidrug resistance modulator PSC 833 (Valspodar). Blood1999;93:787795.

    • Search Google Scholar
    • Export Citation
  • 86.

    WattelESolaryEHecquetB. Quinine improves results of intensive chemotherapy (IC) in myelodysplastic syndromes (MDS) expressing P-glycoprotein (PGP). Updated results of a randomized study. Groupe Francais des Myelodysplasies (GFM) and Groupe GOELAMS. Adv Exp Med Biol1999;457:3546.

    • Search Google Scholar
    • Export Citation
  • 87.

    GreenbergPLLeeSJAdvaniR. Mitoxantrone, etoposide, and cytarabine with or without valspodar in patients with relapsed or refractory acute myeloid leukemia and high-risk myelodysplastic syndrome: a phase III trial (E2995). J Clin Oncol2004;22:10781086.

    • Search Google Scholar
    • Export Citation
  • 88.

    AndersonJEAppelbaumFRFisherLD. Allogeneic bone marrow transplantation for 93 patients with myelodysplastic syndrome. Blood1993;82:677681.

    • Search Google Scholar
    • Export Citation
  • 89.

    De WitteTZwaanFHermansJ. Allogeneic bone marrow transplantation for secondary leukaemia and myelodysplastic syndrome: a survey by the Leukaemia Working Party of the European Bone Marrow Transplantation Group (EBMTG). Br J Haematol1990;74:151155.

    • Search Google Scholar
    • Export Citation
  • 90.

    DemuynckHVerhoefGEZacheeP. Treatment of patients with myelodysplastic syndromes with allogeneic bone marrow transplantation from genotypically HLA-identical sibling and alternative donors. Bone Marrow Transplant1996;17:745751.

    • Search Google Scholar
    • Export Citation
  • 91.

    JuradoMDeegHJStorerB. Hematopoietic stem cell transplantation for advanced myelodysplastic syndrome after conditioning with busulfan and fractionated total body irradiation is associated with low relapse rate but considerable nonrelapse mortality. Biol Blood Marrow Transplant2002;8:161169.

    • Search Google Scholar
    • Export Citation
  • 92.

    KerbauyDMChyouFGooleyT. Allogeneic hematopoietic cell transplantation for chronic myelomonocytic leukemia. Biol Blood Marrow Transplant2005;11:713720.

    • Search Google Scholar
    • Export Citation
  • 93.

    NevillTJFungHCShepherdJD. Cytogenetic abnormalities in primary myelodysplastic syndrome are highly predictive of outcome after allogeneic bone marrow transplantation. Blood1998;92:19101917.

    • Search Google Scholar
    • Export Citation
  • 94.

    ScottBLSandmaierBMStorerB. Myeloablative vs nonmyeloablative allogeneic transplantation for patients with myelodysplastic syndrome or acute myelogenous leukemia with multilineage dysplasia: a retrospective analysis. Leukemia2006;20:128135.

    • Search Google Scholar
    • Export Citation
  • 95.

    WallenHGooleyTADeegHJ. Ablative allogeneic hematopoietic cell transplantation in adults 60 years of age and older. J Clin Oncol2005;23:34393446.

    • Search Google Scholar
    • Export Citation
  • 96.

    AndersonJThomasED. The Seattle experience with bone marrow transplantation for MDS. Leuk Res1997;21(Suppl 1):S51.

  • 97.

    de LimaMAnagnostopoulosAMunsellM. Nonablative versus reduced-intensity conditioning regimens in the treatment of acute myeloid leukemia and high-risk myelodysplastic syndrome: dose is relevant for long-term disease control after allogeneic hematopoietic stem cell transplantation. Blood2004;104:865872.

    • Search Google Scholar
    • Export Citation
  • 98.

    GiraltSEsteyEAlbitarM. Engraftment of allogeneic hematopoietic progenitor cells with purine analog-containing chemotherapy: harnessing graft-versus-leukemia without myeloablative therapy. Blood1997;89:45314536.

    • Search Google Scholar
    • Export Citation
  • 99.

    AndersonJEAnasettiCAppelbaumFR. Unrelated donor marrow transplantation for myelodysplasia (MDS) and MDS-related acute myeloid leukaemia. Br J Haematol1996;93:5967.

    • Search Google Scholar
    • Export Citation
  • 100.

    Castro-MalaspinaHHarrisREGajewskiJ. Unrelated donor marrow transplantation for myelodysplastic syndromes: outcome analysis in 510 transplants facilitated by the National Marrow Donor Program. Blood2002;99:19431951.

    • Search Google Scholar
    • Export Citation
  • 101.

    DeegH. Optimization of transplant regimens for patients with myelodysplastic syndromes (MDS). In: Hematology 2005: American Society of Hematology Education Program Book. Washington, DC: American Society of Hematology; 2005:167173.

    • Search Google Scholar
    • Export Citation
  • 102.

    De WitteTSuciuSVerhoefG. Intensive chemotherapy followed by allogeneic or autologous stem cell transplantation for patients with myelodysplastic syndromes (MDSs) and acute myeloid leukemia following MDS. Blood2001;98:23262331.

    • Search Google Scholar
    • Export Citation
  • 103.

    FukumotoJSGreenbergPL. Management of patients with higher risk myelodysplastic syndromes. Crit Rev Oncol Hematol2005;56:179192.

  • 104.

    AlyeaEPKimHTHoV. Comparative outcome of nonmyeloablative and myeloablative allogeneic hematopoietic cell transplantation for patients older than 50 years of age. Blood2005;105:18101814.

    • Search Google Scholar
    • Export Citation
  • 105.

    CutlerCSLeeSJGreenbergP. A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome. Blood2004;104:579585.

    • Search Google Scholar
    • Export Citation
  • 106.

    LaportGGSandmaierBMStorerBE. Reduced-intensity conditioning followed by allogeneic hematopoietic cell transplantation for adult patients with myelodysplastic syndrome and myeloproliferative disorders. Biol Blood Marrow Transplant2008;14:246255.

    • Search Google Scholar
    • Export Citation
  • 107.

    McCluneBWeisdorfDJDiPersioJF. Non-myeloablative hematopoietic stem cell transplantation in older patients with AML and MDS: Results from the center for International Blood and Marrow Transplant Research (CIBMTR) [abstract]. Blood2008;112:Abstract 346.

    • Search Google Scholar
    • Export Citation
  • 108.

    Kindwall-KellerTIsolaLM. The evolution of hematopoietic SCT in myelodysplastic syndrome. Bone Marrow Transplant2009;43:597609.

  • 109.

    OlianskyDMAntinJHBennettJM. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the therapy of myelodysplastic syndromes: an evidence-based review. Biol Blood Marrow Transplant2009;15:137172.

    • Search Google Scholar
    • Export Citation
  • 110.

    DeegHSandmaierBM. Who is fit for allogeneic transplantation?Blood2010;116:47624770.

  • 111.

    BeranMShenYKantarjianH. High-dose chemotherapy in high-risk myelodysplastic syndrome: covariate-adjusted comparison of five regimens. Cancer2001;92:19992015.

    • Search Google Scholar
    • Export Citation
  • 112.

    WijerMansPSuciuSBailaL. Low dose decitabine versus best supportive care in elderly patients with intermediate or high risk MDS not eligible for intensive chemotherapy: final results of the randomized phase III study (06011) of the EORTC leukemia and German MDS study groups [abstract]. Blood2008;112:Abstract 226.

    • Search Google Scholar
    • Export Citation
  • 113.

    JacobsAJanowska-WieczorekACaroJ. Circulating erythropoietin in patients with myelodysplastic syndromes. Br J Haematol1989;73:3639.

  • 114.

    Hellstrom-LindbergE. Efficacy of erythropoietin in the myelodysplastic syndromes: a meta-analysis of 205 patients from 17 studies. Br J Haematol1995;89:6771.

    • Search Google Scholar
    • Export Citation
  • 115.

    NegrinRSSteinRDohertyK. Maintenance treatment of the anemia of myelodysplastic syndromes with recombinant human granulocyte colony-stimulating factor and erythropoietin: evidence for in vivo synergy. Blood1996;87:40764081.

    • Search Google Scholar
    • Export Citation
  • 116.

    CasadevallNDurieuxPDuboisS. Health, economic, and quality-of-life effects of erythropoietin and granulocyte colony-stimulating factor for the treatment of myelodysplastic syndromes: a randomized, controlled trial. Blood2004;104:321327.

    • Search Google Scholar
    • Export Citation
  • 117.

    Hellstrom-LindbergEAhlgrenTBeguinY. Treatment of anemia in myelodysplastic syndromes with granulocyte colony-stimulating factor plus erythropoietin: results from a randomized phase II study and long-term follow-up of 71 patients. Blood1998;92:6875.

    • Search Google Scholar
    • Export Citation
  • 118.

    Hellstrom-LindbergENegrinRSteinR. Erythroid response to treatment with G-CSF plus erythropoietin for the anaemia of patients with myelodysplastic syndromes: proposal for a predictive model. Br J Haematol1997;99:344351.

    • Search Google Scholar
    • Export Citation
  • 119.

    SpiritiMALatagliataRNiscolaP. Impact of a new dosing regimen of epoetin alfa on quality of life and anemia in patients with low-risk myelodysplastic syndrome. Ann Hematol2005;84:167176.

    • Search Google Scholar
    • Export Citation
  • 120.

    Hellstrom-LindbergEGulbrandsenNLindbergG. A validated decision model for treating the anaemia of myelodysplastic syndromes with erythropoietin + granulocyte colony-stimulating factor: significant effects on quality of life. Br J Haematol2003;120:10371046.

    • Search Google Scholar
    • Export Citation
  • 121.

    MannoneLGardinCQuarreMC. High-dose darbepoetin alpha in the treatment of anaemia of lower risk myelodysplastic syndrome results of a phase II study. Br J Haematol2006;133:513519.

    • Search Google Scholar
    • Export Citation
  • 122.

    MustoPLanzaFBalleariE. Darbepoetin alpha for the treatment of anaemia in low-intermediate risk myelodysplastic syndromes. Br J Haematol2005;128:204209.

    • Search Google Scholar
    • Export Citation
  • 123.

    GiraldoPNomdedeuBLoscertalesJ. Darbepoetin alpha for the treatment of anemia in patients with myelodysplastic syndromes. Cancer2006;107:28072816.

    • Search Google Scholar
    • Export Citation
  • 124.

    StasiRAbruzzeseELanzettaG. Darbepoetin alfa for the treatment of anemic patients with low- and intermediate-1-risk myelodysplastic syndromes. Ann Oncol2005;16:19211927.

    • Search Google Scholar
    • Export Citation
  • 125.

    GreenbergPLSunZMillerKB. Treatment of myelodysplastic syndromes patients with erythropoietin with or without granulocyte colony-stimulating factor: results of a prospective randomized phase III trial by the Eastern Cooperative Oncology Group (E1996). Blood2009;114:23932400.

    • Search Google Scholar
    • Export Citation
  • 126.

    JaderstenMMalcovatiLDybedalI. Erythropoietin and granulocyte-colony stimulating factor treatment associated with improved survival in myelodysplastic syndrome. J Clin Oncol2008;26:36073613.

    • Search Google Scholar
    • Export Citation
  • 127.

    ParkSGrabarSKelaidiC. Predictive factors of response and survival in myelodysplastic syndrome treated with erythropoietin and G-CSF: the GFM experience. Blood2008;111:574582.

    • Search Google Scholar
    • Export Citation
  • 128.

    KornblithABHerndonJEIISilvermanLR. Impact of azacytidine on the quality of life of patients with myelodysplastic syndrome treated in a randomized phase III trial: a Cancer and Leukemia Group B study. J Clin Oncol2002;20:24412452.

    • Search Google Scholar
    • Export Citation
  • 129.

    ThomasM. Health-related quality of life for those with myelodysplastic syndrome: conceptualization, measurement and implications. In: GreenbergPL ed. Myelodysplastic Syndromes: Clinical and Biological Advances. Cambridge, England: Cambridge University Press; 2006:263295

    • Search Google Scholar
    • Export Citation
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