Evolving strategies in the treatment of MDS and AML.

Myelodysplastic syndrome (MDS) is a clonal hematopoietic disorder characterized by a hyperproliferative bone marrow, cellular dysplasia, and ineffective hematopoiesis. This heterogeneous malignancy is composed of several subtypes, the classification of which has evolved over several years. The treatment of MDS involves improving patient survival and quality of life while decreasing the likelihood of progression to acute myelogenous leukemia (AML). In addition to supportive care with transfusions and hematopoietic growth factors as well as stem cell transplantation, three chemotherapeutic agents have been approved to treat MDS--lenalidomide, azacitidine, and decitabine. In addition, multiple agents and novel combinations are currently in development to treat both MDS AML. Several clinical studies which have investigated these therapeutic approaches, as well as the incorporation of new tools used in the diagnosis of MDS, have been published since the 2008 American Society of Hematology (ASH) Annual Meeting and Exposition, and are discussed here. By becoming familiar with these studies, the physician will be better able to provide the optimal treatment for their patients, as well as become aware of novel therapeutic strategies to offer their patients in ongoing clinical trials.