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Myelodysplastic Syndromes in the Elderly: Treatment Options and Personalized Management

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Abstract

Myelodysplastic syndromes (MDS) are typical diseases of the elderly, with a median age of 68–75 years at initial diagnosis. Demographic changes producing an increased proportion of elderly in our societies mean the incidence of MDS will rise dramatically. Considering the increasing number of treatment options, ranging from best supportive care to hematopoietic stem cell transplantation (HSCT), decision making is rather complex in this cohort of patients. Moreover, aspects of the aging process also have to be considered in therapy planning. Treatment of elderly MDS patients is dependent on the patient’s individual risk and prognosis. Comorbidities play an essential role as predictors of survival and therapy tolerance. Age-adjusted models and the use of geriatric assessment scores are described as a basis for individualized treatment algorithms. Specific treatment recommendations for the different groups of patients are given. Currently available therapeutic agents, including supportive care, erythropoiesis-stimulating agents (ESAs), immune-modulating agents, hypomethylating agents, and HSCT are described in detail and discussed with a special focus on elderly MDS patients. The inclusion of elderly patients in clinical trials is of utmost importance to obtain data on efficacy and safety in this particular group of patients. Endpoints relevant for the elderly should be integrated, including maintenance of quality of life and functional activities as well as evaluation of use of healthcare resources.

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Mary Heaney Margreiter proofread the manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine IV (Nephrology and Hematology/Oncology), Klinikum Wels-Grieskirchen, Wels, Austria

    Sonja Burgstaller

  2. Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Petra Wiesinger & Reinhard Stauder

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  1. Sonja Burgstaller
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Correspondence to Reinhard Stauder.

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This work was supported by ‘Austrian Science Fund (FWF): Projekt I 1576-B19’ and by Verein Seniorenkrebshilfe.

Conflicts of interest

SB has received research support from Celgene and honoraria from Celgene, Novartis, and AOP. RS has received research support from Celgene and TEVA, honoraria from Celgene, Teva, and Novartis, and is a scientific advisory board member of Celgene. PW declares no potential conflicts of interest.

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Burgstaller, S., Wiesinger, P. & Stauder, R. Myelodysplastic Syndromes in the Elderly: Treatment Options and Personalized Management. Drugs Aging 32, 891–905 (2015). https://doi.org/10.1007/s40266-015-0312-7

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