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  Česky / Czech version Trans. Hemat. dnes, 10, 2004, No. 4, p. 161–168.
 
Overview of conservative treatment of myelodysplastic syndrom over the twenty years and new drugs for the future 
Neuwirtová R. 

I. interní klinika, VFN, 1. LF UK, Praha
 


Summary:

       Successful treatment of myelodysplastic syndrom has already been revealing over the last 20 years.The purpose of this paper is to show summary of conservative treatment of MDS indicated so far. The treatment of cytopenic patients is different in contrast to treatment of leukemic ones. Drugs used for the treatment of cytopenic patients could delay early apoptosis and enable sufficient cell maturation. Ineffective are vitamins, corticosteroids, anabolic steroids, amifostine from antioxidants, interferons, antiapoptotic mixtures. Cytokines (namely erythropoietin, also used in combinations) and drugs operating by various mechanisms one of which suppress tumor necrosis factor (cyclosporin A, ATG, infliximab, thalidomide and Revlimid - analogue of thalidomide) belong to the accepted therapeutic approaches. Iron chelation is sufficient as well. Effective treatment usually do not exceed 30%.Leukemic patients suffering from MDS younger than 60 years are treated in the same way as AML patients using aggressive chemotherapy. This type of treatment, together with transplantation, is already not counted to conservative treatment of MDS. Treatment of elderly patients is recommended to be a combination of less aggressive or only low doses of cytostatics. A big prospect for cancer patients, including MDS patients, present inhibitors of molecules regulating cell growth and death. Inhibitors of methyltransferase (azacytidine and deoxyazacytidine) have already entered Phase III trial and the others are administrated as monotherapy or combined with other cytostatic drugs in Phase II trial in treatment of MDS.

        Key words: myelodysplastic syndrom, cytopenic patients, leukemic patients, therapy
       

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