1. Bennett JM, et al.: Proposals for the classification of the acute leukaemias. French-American-British (FAB) cooperative group. Br J Haemato l 33(4):451-458, 1976.

2. Bennett JM: World Health Organization classification of the acute leukemias and myelodysplastic syndrome. Int J Hemato l 72(2):131-133, 2000.

3. Greenberg P, et al.: International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood 89(6):2079-2088, 1997.

4. Cleeland CS, et al.: Identifying hemoglobin level for optimal quality of life: results of an incremental analysis [abstract]. Proc Am Soc Clin Oncol 18:574a, 1999. Abstract 2215.

5. Saif MW, Hopkins JL, Gore SD: Autoimmune phenomena in patients with myelodysplastic syndromes and chronic myelomonocytic leukemia. Leuk Lymphoma 43(11):2083-2092, 2002.

6. Anderson LJ, et al.: Cardiovascular T2-star (T2*) magnetic resonance for the early diagnosis of myocardial iron overload. Eur Heart J 22(23):2171-2179, 2000.

low- or high-intensity therapies (e.g., AML-like treatment regimens) in clinical trials whenever possible.

3. Patients at great risk for progressing to AML: Patients with increased BM blasts and/or poor risk cytogenetics have a high likelihood of transforming to AML, and AML arising in a patient with MDS has an extremely poor prognosis. Thus, allogeneic stem cell transplant should be considered for such poor prognosis MDS patients as soon as possible. Many MDS patients will not be suitable transplant candidates based on their performance status, other complicating medical problems, age, or lack of a suitable donor. Improvements in unrelated donor transplantation may provide more hope for these patients in the future. A major risk for these patients post-stem cell transplant is disease relapse. Whether using 5-azacytidine, or standard AML induction therapy, to reduce the BM blast count prior to transplantation will improve transplant outcomes, is not known. It is a vitally important question to address. Patients who are not eligible for a stem cell transplant should be treated with 5-azacytidine, or with investigational therapy in the setting of a clinical trial.

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