Myelodysplastic syndrome (MDS) is primarily a hematological malignancy of aging. Eighty percent of cases are diagnosed in adults > age 70 who experience considerable symptom burden and a high rate of health care utilization.1 Estimated 3-year survival rates are less than 50%.2 The presence of comorbidity further shortens survival independent of age.3, 4
An older adult presenting with cytopenia and a progressive macrocytic anemia is a common presentation of new MDS.5 A bone marrow biopsy with cytogenetic analysis is needed to confirm the diagnosis. Treatment varies by risk parameters which are stratified into subgroups primarily delineated by cytogenetic abnormalities.
In general, the management of low-risk patients with MDS focuses on reducing disease-associated morbidity and maximizing quality of life. In high-risk patients, treatment goals include altering the natural history of MDS with antineoplastic agents. All risk categories require considerable supportive care such as transfusion support and antibiotics. Ultimately, transfusion dependence has deleterious effects, namely an increased risk for iron overload, a concern in older adults with preexisting cardiac and liver disease.
Currently, the only curative therapy for MDS is allogeneic hematopoietic stem cell transplantation (HSCT) which historically was not a treatment option offered to older adults. Now, however, a patient’s physiologic age versus chronologic age is used to determine appropriateness of HSCT in this age group. It is reserved for a subset of older patients with good functional status, minimal comorbidity, and high-risk MDS.6 With contemporary reduced-intensity conditioning regimens and careful choice of appropriate patients, HSCT can now be successfully performed in elderly patients.7
Despite an increasing number of treatment options for older adults with MDS, a significant number of patients will still require end-of-life care following diagnosis. A recent analysis of nearly 2,000 MDS patients revealed that only half were enrolled in hospice care.8 The researchers noted that common hospice enrollment criteria frequently disallow transfusion-dependent patients which may preclude MDS patients from receiving necessary care at the end of life.
Due to population aging projections, the future of cancer care will be characterized by a growing number of older age-associated malignancies. Cases of MDS then will likely increase in number; hence, expertise in the nursing care of these patients will be required.
We must keep current on the treatment and supportive care advances in the management of MDS as we ready ourselves for an evolving future.
Efficace F, Gaidano G, Breccia M, et al. Prevention, severity, and correlates of fatigue in newly diagnosed patients with myelodysplastic syndromes. Br J Haematol. 2015 Feb;168(3):361-70.
Rollison DE, Howlader N, Smith MT, et al. Epidemiology of myelodysplastic syndromes and chronic myeloproliferative disorders in the United States, 2001–2004, using data from the NAACCR and SEER programs. Blood. 2008 Jul 1;112(1):45-52.
Naqvi K, Garcia-Mannero G, Sardesai S, et al. Association of comorbidities with overall survival in myelodysplastic syndromes: Development of a prognostic model. J Clin Oncol. 2011 Jun 1;29(16):2240-6.
Balleari E, Salveti C, Del Corso L, et al. Age and comorbidities deeply impact on clinical outcome of patients with myelodysplastic syndromes. Leuk Res. 2015 Aug;39(8):846-52.
Klepin HD. Myelodysplastic Syndromes and Acute Myeloid Leukemia in the Elderly. Clin Geriatr Med. 2016 Feb;32(1):155-73.
Klepin HD, Rao AV, Pardee TS. Acute myeloid leukemia and myelodysplastic syndrome in older adults. J Clin Oncol. 2014 Aug 20;32(24):2541-52.
Pohlen M, Groth C, Sauer T, et al. Outcome of allogeneic stem cell transplant for AML and myelodysplastic syndrome in elderly patients (> 60 years). Bone Marrow Transplant. 2016 Nov;51(11):1441-1448.
Fletcher SA, Cronin AM, Zeidan AM, et al. Intensity of end-of-life care for patients with myelodysplastic syndromes: Findings from a large national database. Cancer. 2016 Apr 15;122(8):1209-15.
FDA Approves Onivyde for Advanced Pancreatic Cancer Marijke Vroomen Durning, RN, 10/27/2015 3 On October 22, 2015, the US Food and Drug Administration (FDA) approved Onivyde (irinotecan liposome injection, Merrimack Pharmaceuticals, Inc.), in combination with fluorouracil ...