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New review explains current treatment approaches for myelodysplastic syndromes
Medical scientists at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine have published a review in the Journal of the American Medical Association that explains current treatment approaches for myelodysplastic syndromes (MDS), which are rare and often fatal bone marrow cancers. For years, MDS was incorrectly referred to as a precancerous condition. To remedy this, the World Health Organization (WHO) recently reclassified MDS to recognize its severity. MDS is rarely described as cancer. In the vast majority of cases, MDS patients, mostly older adults, are told that they have a blood disorder or a bone marrow disorder. The WHO reclassification really emphasizes that this...
New review explains current treatment approaches for myelodysplastic syndromes
Medical scientists at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine have published a review in the Journal of the American Medical Association that explains current treatment approaches for myelodysplastic syndromes (MDS), which are rare and often fatal bone marrow cancers.
For years, MDS was incorrectly referred to as a precancerous condition. To remedy this, the World Health Organization (WHO) recently reclassified MDS to recognize its severity.
MDS is rarely described as cancer. In the vast majority of cases, MDS patients, mostly older adults, are told that they have a blood disorder or a bone marrow disorder. The WHO reclassification really emphasizes that this is not a precancerous condition -; it’s cancer.”
Mikkael Sekeres, MD, head of the Division of Hematology and co-author of the paper
Dr. Sekeres doesn't have to go far to prove his point. The survival curves of MDS and lung cancer are quite similar. “No one would dispute the seriousness of a lung cancer diagnosis,” he said, “and no one should overlook the seriousness of MDS.”
Patients with MDS have a decrease in peripheral blood cells and are at higher risk of acute myeloid leukemia (AML). The disease is divided into subtypes based on the patient's risk of developing AML. Patients with low-risk diseases have a survival rate of three to ten years. For people at higher risk of disease, the median survival time is less than three years. 5-year survival for all MDS subtypes is 37%
Treatment approaches based on risk profiles
The review article discusses the different treatment approaches, based largely on each person's individual disease, and is aimed at clinicians to help them better care for patients based on their MDS risk profiles.
"MDS is a diagnosis in older adults, so it is particularly relevant to South Florida's aging population," said Dr. Sekeres. "Because low blood counts can be a normal consequence of aging, the disease tends to be underdiagnosed. A particular patient may not have MDS, but if they do have low blood counts, they should be referred to a hematologist for further advice."
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This is doubly important because MDS is a highly complex disease. Accurate diagnosis, preferably at an academic medical center, is critical to ensure that patients are neither over- nor undertreated. “Because MDS is so heterogeneous, each patient’s treatment plan should be tailored to that person,” said Dr. Sekeres. “There is no one-size-fits-all approach.”
Dr. Sekeres and co-author Assistant Professor Justin Taylor, MD, are both optimistic that new treatments and combinations will further improve MDS survival rates.
“We had some new drugs that target the genetic basis of MDS,” said Dr. Sekeres. "I think we're on the verge of combination therapy to treat higher-risk diseases. MDS is one of the few cancers where we don't combine drugs to treat it, so that's a big deal."
Other MDS study
Dr. Sekeres recently contributed to another study in the New England Journal of Medicine, led by researchers at MD Anderson Cancer Center in Houston, which produced encouraging results. The research showed that 67% of patients with low-risk diseases responded well to low doses of decitabine, a drug that helps the bone marrow produce healthy blood cells.
“This was an important study because it showed that less is more,” said Dr. Sekeres. “Giving less chemotherapy resulted in more patients benefiting from the treatment.”
The study was conducted by the MDS Clinical Research Consortium led by Dr. Sekeres conducted and is one of a number of recent studies that offer good news for MDS patients.
“As an oncologist, I think you have to be optimistic,” said Dr. Taylor. “But I see a bright future for drugs approved for MDS.”
Source:
Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
Reference:
Sekeres, MA & Taylor, J., (2022) Diagnosis and treatment of myelodysplastic syndromes. A review. JAMA. doi.org/10.1001/jama.2022.14578.
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