Myeloid disease: Edited by Martin S. TallmanOptimal sequencing of treatments for patients with myelodysplastic syndromesItzykson, Raphaela; Fenaux, Pierrea,bAuthor Information aService d'hématologie clinique, Hôpital Avicenne, (Assistance Publique-Hôpitaux de Paris, AP-HP), Paris 13 University, Bobigny, France bINSERM Unit 848, Institut Gustave Roussy, Villejuif, France Correspondence to Pierre Fenaux, MD, PhD, Service d'hématologie clinique, Hôpital Avicenne/Paris 13 University, 125 rue de Stalingrad, 93009 Bobigny, France E-mail: [email protected] Current Opinion in Hematology: March 2009 - Volume 16 - Issue 2 - p 77-83 doi: 10.1097/MOH.0b013e3283257a74 Buy Metrics Abstract Purpose of review Myelodysplastic syndromes (MDS) are characterized by chronic cytopenias and a high risk of transformation to acute myeloid leukemia. To date, only allogeneic stem cell transplantation has shown curative potential in MDS. The heterogeneous nature of MDS, and the paucity of randomized studies make individual therapeutic decisions, still largely based on the international prognostic scoring system, difficult. Recent findings In lower-risk MDS, recent advances include demonstration of a possible survival advantage with erythropoiesis stimulating agents, the role of lenalidomide in cases with del 5q (which lead to its approval in the treatment of lower-risk MDS with del 5q by the Food and Drug Administration), and recognition of the importance of iron overload on prognosis. In higher-risk patients, progress has come from the use of reduced intensity conditioning allogeneic SCT in elderly patients, and from results obtained with the hypomethylating agents azacytidine and decitabine, leading to their approval for the treatment of symptomatic MDS by the Food and Drug Administration. In particular, results of a phase III trial show a significant survival benefit for azacytidine over conventional treatments in higher-risk MDS. This is the first time a drug demonstrates a survival impact in higher-risk MDS. Summary We review these recent advances in this paper. © 2009 Lippincott Williams & Wilkins, Inc.