Overview of conservative treatment of myelodysplastic syndrom overthe twenty years and new drugs for the future

Overview

Successful treatment of myelodysplastic syndrom has already been revealing over the last 20 years.Thepurpose of this paper is to show summary of conservative treatment of MDS indicated so far. Thetreatment of cytopenic patients is different in contrast to treatment of leukemic ones. Drugs used forthe treatment of cytopenic patients could delay early apoptosis and enable sufficient cell maturation.Ineffective are vitamins, corticosteroids, anabolic steroids, amifostine from antioxidants, interferons,antiapoptotic mixtures. Cytokines (namely erythropoietin, also used in combinations) and drugsoperating by various mechanisms one of which suppress tumor necrosis factor (cyclosporin A, ATG,infliximab, thalidomide and Revlimid - analogue of thalidomide) belong to the accepted therapeuticapproaches. Iron chelation is sufficient as well. Effective treatment usually do not exceed 30%.Leukemicpatients suffering from MDS younger than 60 years are treated in the same way as AML patients usingaggressive chemotherapy. This type of treatment, together with transplantation, is already not countedto conservative treatment of MDS. Treatment of elderly patients is recommended to be a combinationof less aggressive or only low doses of cytostatics. A big prospect for cancer patients, including MDSpatients, present inhibitors of molecules regulating cell growth and death. Inhibitors of methyltransferase(azacytidine and deoxyazacytidine) have already entered Phase III trial and the others areadministrated as monotherapy or combined with other cytostatic drugs in Phase II trial in treatmentof MDS.

Key words:
myelodysplastic syndrom, cytopenic patients, leukemic patients, therapy