Abstract
Myelodysplastic syndromes (MDS) represent a heterogeneous group of clonal hematologic neoplasms characterized by morphologic dysplasia, aberrant hematopoiesis and peripheral blood refractory cytopenias. MDS is recognized to be associated with an increased risk of symptomatic anemia, infectious complications and bleeding diathesis, as well as a risk of progression to acute myeloid leukemia, particularly in patients with a high IPSS score. The advent of use of hematopoietic growth factors such as granulocyte colony-stimulating factor (G-CSF) and recombinant erythropoietin (EPO) has improved symptoms in MDS patients in addition to some data that suggest there might be an improvement in survival. G-CSF is an effective therapeutic option in MDS patients, and it should be considered for the management of refractory symptomatic cytopenias. G-CSF and EPO in combination can improve outcomes in appropriate MDS patients such as those with lower-risk MDS and refractory anemia with ring sideroblasts (RARS) . This article reviews use of growth factors for lower-risk MDS patients, and examines the data for G-CSF, EPO and thrombopietic growth factors (TPO) that are available or being developed as therapeutic modalities for this challenging disease.
Highlights
The myelodysplastic syndromes (MDS) represent a diverse group of clonal hematologic neoplasms in which abnormal multipotent progenitor cells are involved
Myelodysplastic syndromes (MDS) affects approximately 1 in 500 persons over 60 years of age, making it the most common hematologic malignancy in this age group (Sekeres, 2011; Bennett et al, 1982; Vardiman et al, 2009).The best survival for MDS patients is in the category of refractory anemia (RA) with a median of 28 months, and the worst median survival seen in refractory anemia with excess blast (RAEB) with median of 11 months (Ma et al, 2007)
This study revealed an U/L) was observed in a Greek phase II clinical study in interesting finding that approximately 50% of the MDS 281 MDS patients (RA, refractory anemia with ring sideroblasts (RARS), and RAEB) and an overall patients with a response to granulocyte colony-stimulating factor (G-colony stimulating factors (CSFs)) and EPO combination erythroid response rate of 45.1% was reported (Terpos et lost their response with G-CSF withdrawal, and some of al., 2002)
Summary
The myelodysplastic syndromes (MDS) represent a diverse group of clonal hematologic neoplasms in which abnormal multipotent progenitor cells are involved. In a randomized prospective study on 93 patients with RAEB-t and MDS-AML, the addition of GM-CSF to standard induction chemotherapy schedule did not improve the complete remission and survival rate, and was associated with more side effects.
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