Managing Myelodysplastic Symptoms in Elderly Patients

Articles MDS published on April 21, 2014

Ria R, et al. Managing Myelodysplastic Symptoms in Elderly Patients. Clin Interv Aging. 2009;4:413-423.

The median age of patients with myelodysplastic syndrome (MDS) is 65 to 70, and there is some debate about the need, or risk/benefit ratio, of treating these patients aggressively. As the population ages, the need increases for more clarification regarding which older patients are most suitable for the different therapeutic options. The article by Ria, et al., describes the epidemiology of MDS, the clinical features, the problem of anemia and its treatment, and the management of other cytopenias, especially as these topics relate to the elderly. Treatment strategies for MDS can be curative (stem cell transplant) or non-curative (growth factors, differentiating agents, chemotherapy). New strategies include lenalidomide and methyltransferase inhibitors. While many older patients cannot tolerate these interventions, many others can.

The approach to MDS in the elderly should be individualized, as numerous factors influence the potential inability of the older patient to tolerate intensive treatments. Age-related decline in normal bone marrow function should be evaluated, and clinicians must aim to determine if the patient has an indolent or progressive course and has isolated or more aggressive anemia. In short, patients should not only be categorized by age but by comorbidities and by stable versus unstable disease, before proceeding on a treatment course.

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Last modified: April 21, 2014