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Myelodysplastic syndrome ( MDS ) is a malignancy of the bone marrow result in a reduction of the healthy blood cells . The incidence of myelodysplastic syndrome is about 3.3 - 4.5 cases per 100,000 and the relative incidence is increasing each yr , it is more common in White , elderly ( normally , occur in the 7th decennium ) manlike patients . A recent report has shown the relative incidence is about 75 per 100,000 in people age more than 65 years , 86 % patients diagnosed with myelodysplastic syndrome are more than 60 years ( mean value age of 76 class ) and only 6 % of patients were diagnosed on or before age 50.(1 )
How Is Myelodysplastic Syndrome Treated In The Elderly?
If myelodysplastic syndrome is not treated , it invariably get on into acute myeloid leukemia ( AML ) , there are several types of myelodysplastic syndrome , some eccentric seldom build and some are common to advance into AML . The treatment method for elderly people remain controversial , the type of myelodysplastic syndrome and rigour , the age , comorbidities , and permissiveness to the discussion are important aspects to view before initiation of intervention . years per se does not circumscribe treatment as some patient tolerate discourse well . Some conceive lenitive care with supportive handling is the good way . The ultimate goal of treatment is to prolong survival , cut symptom and improve quality of life .
Hypomethylating Agents – Hypomethylating agents can be used to do by humiliated - risk pattern , drugs such as azacytidine ( Vidaza ) and decitabine ( Dacogen ) are the first choice . These drugs increase the line of descent counts , keep down the issue of transfusions needed , reduce the risk of developing AML , prolong survival , and improve lineament of life . These drug have side effects similar to received chemotherapy drugs but milder than those drug . One of the master side effects is it reduces the line counts ab initio and take some fourth dimension for the drug response . Other side effects includefatigue , fever , sickness / vomiting , diarrheaorconstipation . Other standardchemotherapyagents are less effective , but cytarabine , idarubicin , daunorubicin are used in some instances .
Immunomodulating Drugs – Myelodysplastic syndrome with isolated del ( 5q ) type ( mutation in chromosome 5 ) can be treated with lenalidomide ( Revlimid ) as the first choice , which is an immunomodulating drug . If it does n’t work azacytidine can be used . Lenalidomide can also be used for other low - level myelodysplastic syndrome types as well . It also reduces the need for blood blood transfusion for some time . The side essence are lower stemma count , fatigue , diarrhea , and constipation .
Immunosuppressive drug – Immunosuppressive drug such as cyclosporine and anti - thymocyte globulin ( ATG ) can be used for patients with a low number of mobile phone in thebone meat .
Allogeneic Stem Cell Transplantation – Allogeneic stem cell transplantation ( allo - HSCT ) is the only classic remedy for myelodysplastic syndrome . However , allo - HSCT is not done normally in elderly patient role as transplantation have a gamy morbidity and death rate , most elderly patients have other comorbidities , discover a compatible donor is also a problem at this age . Therefore , usually , done in patients less than 60 years and unfortunately most patients are not campaigner for organ transplant .
Supportive Care And Other Treatment – If blood count are low supportive charge discourse with blood transfusions and parentage cellphone growth factors can be given . Prophylactic discussion to prevent infections and treatment of infections involve to be done as well.(2 )
Conclusion
The treatment of myelodysplastic syndrome in the elderly remains controversial . Most patient role diagnose with myelodysplastic syndrome are elderly affected role most in all probability with other comorbidities . Some consider they should be offered alleviative concern with supportive treatment and some field have turn out that drug prolong their life story and melt off the risk of develop AML ; however , some patients do not tolerate these aggressive discussion . The goal of treatment is to prolong lifespan , cut down symptoms , and improve quality of life . When prefer a intervention architectural plan to a patient , the risks and benefit of the treatment should be taken into accounting . The treatment options are hypomethylating agents ( azacytidine and decitabine ) , lenalidomide , immunosuppressive agent ( cyclosporine and ATG ) , allogeneic root word cell transplant ( not done normally ) , supportive like with line of descent blood transfusion , blood cell ontogeny factor , and bar of contagion ; and palliative care .
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