Hellström-Lindberg Eva, Malcovati Luca
Karolinska Institutet, Department of Medicine, Division of Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Semin Hematol. 2008 Jan;45(1):14-22. doi: 10.1053/j.seminhematol.2007.10.004.
Supportive care constitutes the basis of the management of patients with myelodysplastic syndromes (MDS). Appropriate treatment of cytopenia, as well as of other related complications, not only improves quality of life but also may positively affect the overall survival of patients. Anemia is the most common cytopenia in MDS, and the requirement for regular transfusions is a major clinical problem for patients with low-risk MDS. An important therapeutic goal in this patient group is to maintain acceptable hemoglobin levels without transfusions. Today, this goal can be achieved by treatment with erythropoietin (Epo) +/- granulocyte colony-stimulating factor (G-CSF), or by more targeted treatment such as antithymocyte globulin or lenalidomide in around 50% of patients. For the remaining patients, and for those who lose their therapeutic response, chronic transfusion therapy, with or without the addition of chelating agents, is the only option and it is important that this treatment is scheduled to meet the needs of the individual patient. Severe thrombocytopenia has recently been reported to respond to thrombopoietic agents, such as AMG 531.
支持性治疗是骨髓增生异常综合征（MDS）患者管理的基础。对血细胞减少症以及其他相关并发症进行适当治疗，不仅能提高生活质量，还可能对患者的总生存期产生积极影响。贫血是MDS中最常见的血细胞减少症，对于低危MDS患者而言，定期输血的需求是一个主要的临床问题。该患者群体的一个重要治疗目标是在不输血的情况下维持可接受的血红蛋白水平。如今，约50%的患者可通过促红细胞生成素（Epo）+/-粒细胞集落刺激因子（G-CSF）治疗，或通过更具针对性的治疗，如抗胸腺细胞球蛋白或来那度胺来实现这一目标。对于其余患者以及那些失去治疗反应的患者，无论是否添加螯合剂，慢性输血治疗都是唯一的选择，并且重要的是，这种治疗应根据个体患者的需求进行安排。最近有报道称，严重血小板减少症对血小板生成剂，如AMG 531有反应。
