Treatment Optionsoverview

The choice of therapy, and the decision to undergo treatment, must be tailored to the individual patient. In general, the factors that govern these decisions include patient age, performance status, and medical comorbidities, as well as the patient's risk-aversion profile and the severity of the disease at presentation. MDSs are not curable without stem cell transplantation. However, the combination of advanced age and limited donor availability renders the vast majority of patients with MDS ineligible for such therapy. Intensive antileukemic chemotherapy may alter the natural history of MDS in some patients, but candidates for this therapy must be selected carefully to avoid excessive risk in this aging, medically vulnerable population.

Although supportive care remains a mainstay of treatment for many patients with low-risk, largely asymptomatic disease, the ability to impact the natural history of this disease in symptomatic (and possibly asymptomatic) patients now and in the future is exciting. Given the current state of the field, and paucity of curable options, patients with MDS should be treated on clinical protocols, if at all possible.

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