Treatment of Myelodysplastic Syndromes for Older Patients: Current State of Science, Challenges, and Opportunities

IF 2.7 3区医学 Q2 HEMATOLOGY

Current Hematologic Malignancy Reports Pub Date : 2024-04-18 DOI:10.1007/s11899-024-00733-y

Tariq Kewan, Maximillian Stahl, Jan Philipp Bewersdorf, Amer M. Zeidan

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引用次数: 0

Abstract

Purpose of Review

Myelodysplastic syndromes/neoplasms (MDS) represent a diverse group of pathologically distinct diseases with varying prognoses and risks of leukemia progression. This review aims to discuss current treatment options for elderly patients with MDS, focusing on patients ineligible for intensive chemotherapy or allogenic hematopoietic stem cell transplantation (HSCT). The challenges associated with treatment in this population and emerging therapeutic prospects are also explored.

Recent Findings

Recent advancements in molecular diagnostics have enhanced risk stratification by incorporating genetic mutations, notably through the molecular International Prognostic Scoring System (IPSS-M). Lower-risk MDS (LR-MDS) treatment ranges from observation to supportive measures and erythropoiesis-stimulating agents (ESAs), with emerging therapies like luspatercept showing promise. High-risk MDS (HR-MDS) is treated with hypomethylating agents (HMAs) or allogenic HSCT, but outcomes remain poor.

Summary

Elderly MDS patients, often diagnosed after 70, pose challenges in treatment decision-making. The IPSS-M aids risk stratification, guiding therapeutic choices. For LR-MDS, supportive care, ESAs, and novel agents like luspatercept are considered. Treatment of HR-MDS involves HMAs or allogenic HSCT. Emerging treatments, including oral HMAs and novel agents targeting FLT3, and IDH 1/2 mutations, show promise. Future research should refine treatment strategies for this elderly population focusing on quality-of-life improvement.

Abstract Image

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老年骨髓增生异常综合征的治疗：科学现状、挑战与机遇

综述目的骨髓增生异常综合征/肿瘤（MDS）是一组病理上截然不同的疾病，其预后和白血病进展风险各不相同。本综述旨在讨论老年MDS患者的现有治疗方案，重点关注不符合强化化疗或异体造血干细胞移植（HSCT）条件的患者。最近的研究结果最近分子诊断技术的进步，特别是通过分子国际预后评分系统（IPSS-M），结合基因突变加强了风险分层。低危MDS（LR-MDS）的治疗方法包括观察、支持措施和红细胞生成刺激剂（ESAs），新出现的治疗方法如luspatercept显示出良好的前景。高危MDS（HR-MDS）采用低甲基化药物（HMAs）或异基因造血干细胞移植治疗，但疗效仍然不佳。摘要老年MDS患者通常在70岁以后确诊，这给治疗决策带来了挑战。IPSS-M有助于风险分层，指导治疗选择。对于 LR-MDS，可考虑支持治疗、ESAs 和新型药物（如 luspatercept）。HR-MDS的治疗包括HMAs或异基因造血干细胞移植。新出现的治疗方法，包括口服HMAs和针对FLT3及IDH 1/2突变的新型药物，都显示出治疗前景。未来的研究应完善针对这一老年人群的治疗策略，重点关注生活质量的改善。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Hematologic Malignancy Reports ONCOLOGY-HEMATOLOGY

CiteScore

6.00

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： his journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of hematologic malignancy. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as leukemia, lymphoma, myeloma, and T-cell and other lymphoproliferative malignancies. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.