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In the last decade, significant advances have been made in the treatment of patients with Myelodysplastic Syndromes (MDS). Although best supportive care continues to have an important role in the management of MDS, todate the therapeutic approach is diversified according to IPSS risk group, karyotype, patient’s age, comorbidities, and compliance.
Hematopoietic growth factors play a major role in lower risk MDS patients, and include high dose erithropoiesis stimulating agents, which were shown to prolong survival, and thrombopoietic receptor agonists. Standard supportive care should also include iron chelating therapy to reduce organ damage related to iron overload in transfusion-dependent patients. Biologic therapies have been introduced in MDS, with lenalidomide, which has been shown to induce transfusion independence in most patients with the 5q- Syndrome. Hypomethylating agents have shown efficacy in INT-2/high risk MDS patients, reducing the risk of leukemic transformation and increasing survival. Other agents under development for the treatment of MDS include histone deacetylase inhibitors, farnesyltransferase inhibitors, clofarabine and ezatiostat.