Myelodysplastic syndromes

Myelodysplastic syndromes (MDS) are characterized clinically by a hyperproliferative bone marrow and peripheral blood cytopenias because of ineffective hematopoiesis. Clonal in origin, MDS was often thought to represent a preneoplastic or preleukemic state; however, more than half of patients die from complications of MDS without evolving to acute myeloid leukemia (AML). Diagnosis is made by excluding other etiologies of cytopenias, and on morphologic and cytogenetic findings from a bone marrow biopsy, which are used to determine prognosis and treatment. Supportive therapies such as erythropoiesis stimulating agents and transfusions are the mainstay of treatment for low risk MDS, while hypomethylating agents and in some cases stem cell transplant are the first line treatments for patients with high risk disease.