Diagnosis and treatment of primary myelodysplastic syndromes in adults: recommendations from the European LeukemiaNet
Luca Malcovati, Eva Hellström-Lindberg, David Bowen, Lionel Adès, Jaroslav Cermak, Consuelo Del Cañizo, Matteo G Della Porta, Pierre Fenaux, Norbert Gattermann, Ulrich Germing, Joop H Jansen, Moshe Mittelman, Ghulam Mufti, Uwe Platzbecker, Guillermo F Sanz, Dominik Selleslag, Mette Skov-Holm, Reinhard Stauder, Argiris Symeonidis, Arjan A van de Loosdrecht, Theo de Witte, Mario Cazzola, European Leukemia Net, Luca Malcovati, Eva Hellström-Lindberg, David Bowen, Lionel Adès, Jaroslav Cermak, Consuelo Del Cañizo, Matteo G Della Porta, Pierre Fenaux, Norbert Gattermann, Ulrich Germing, Joop H Jansen, Moshe Mittelman, Ghulam Mufti, Uwe Platzbecker, Guillermo F Sanz, Dominik Selleslag, Mette Skov-Holm, Reinhard Stauder, Argiris Symeonidis, Arjan A van de Loosdrecht, Theo de Witte, Mario Cazzola, European Leukemia Net
Abstract
Within the myelodysplastic syndrome (MDS) work package of the European LeukemiaNet, an Expert Panel was selected according to the framework elements of the National Institutes of Health Consensus Development Program. A systematic review of the literature was performed that included indexed original papers, indexed reviews and educational papers, and abstracts of conference proceedings. Guidelines were developed on the basis of a list of patient- and therapy-oriented questions, and recommendations were formulated and ranked according to the supporting level of evidence. MDSs should be classified according to the 2008 World Health Organization criteria. An accurate risk assessment requires the evaluation of not only disease-related factors but also of those related to extrahematologic comorbidity. The assessment of individual risk enables the identification of fit patients with a poor prognosis who are candidates for up-front intensive treatments, primarily allogeneic stem cell transplantation. A high proportion of MDS patients are not eligible for potentially curative treatment because of advanced age and/or clinically relevant comorbidities and poor performance status. In these patients, the therapeutic intervention is aimed at preventing cytopenia-related morbidity and preserving quality of life. A number of new agents are being developed for which the available evidence is not sufficient to recommend routine use. The inclusion of patients into prospective clinical trials is strongly recommended.
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Source: PubMed