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Management of Anaemia in MDS
Author(s) -
Killick S.
Publication year - 2006
Publication title -
transfusion medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 59
eISSN - 1365-3148
pISSN - 0958-7578
DOI - 10.1111/j.1365-3148.2006.00693_44.x
Subject(s) - medicine , myelodysplastic syndromes , erythropoietin , disease , quality of life (healthcare) , incidence (geometry) , anemia , intensive care medicine , bone marrow , blood transfusion , red cell , pediatrics , physics , nursing , optics
The myelodysplastic syndromes (MDS) are clonal disorders of haemopoeisis. They share characteristic morphological abnormalities of the blood and bone marrow and a risk of evolution to acute leukaemia which varies according to the subtype of MDS and the prognostic score (IPSS). Overall annual incidence rates based on European studies are between 3 and 4 per 100 000 but the rate dramatically increases with age, exceeding 30 per 100 000 for patients over 80 years. It is therefore mainly a disease seen in older patients, where curative treatments are not an option, and supportive care is the reality. The majority of patients are anaemic at diagnosis and red cell transfusions are the mainstay of supportive care in those symptomatic. The aim is to achieve a haemoglobin level to maximise the patient's quality of life (QOL), which should be tailored to the individual. Red cell transfusions do however have risks associated, including the development of red cell antibodies and iron overload in multi‐transfused patients. Iron chelation therapy, due to its mode of delivery, further impacts on QOL. Alternatives to transfusions include growth factors and disease modifying agents. The aim of using Erythropoietin (EPO), is to improve the overall QOL by avoiding fluctuations in the haemoglobin levels. It also has the benefit therefore of avoiding the risks of transfusion. Unfortunately, it has been shown that those who would benefit most, are least likely to respond. Overall response rates (100% reduction in transfusion requirements) are in the order of 16–24%. Other options to avoid multiple transfusions are by modifying the disease. There are a number of approaches available including stem cell transplantation, immunosuppression, demethylating agents (azacitidine, decitabine) and thalidomide analogues (Lenalidomide). These should be tailored to the individual patient and where possible patients should be treated within clinical research protocols.