Stratification according to the risk categories described above is necessary to determine the therapeutic efficacy of various treatment regimens. A younger patient with a more aggressive form of MDS probably warrants aggressive systemic treatment, while an elderly patient with an indolent form of the disease probably should receive only supportive care. Chemotherapeutic options for this condition range from intensive cytotoxic therapy to low-dose treatment modalities. 7,8 The best results have been achieved in younger patients and in those with more favorable karyotypes. 9 Corticosteroids and androgens have also been tried.
Some patients respond transiently, but no benefit in long-term survival has been achieved.
In many patients, the neutrophil count rises and remains elevated as long as the drug is continued. Not surprisingly, no significant change in platelet count occurs with G-CSF therapy. A recent study from Seattle evaluated myeloablative therapy followed by allogeneic transplantation using unrelated donors. These results indicate that matched unrelated donor transplantation may be an effective treatment for MDS in young patients with few blasts. In summary, MDS is characterized by dysplastic changes in at least two of the three blood cell lineages in the bone marrow.