Treatment Options for Myelodysplastic Syndromes in Older Adults

Myelodysplastic syndromes (MDS) are a group of disorders characterized by the ineffective production of blood cells in the bone marrow. In older adults, MDS is typically classified into low-risk, intermediate-risk, and high-risk categories based on disease severity and genetic markers. Accurate risk stratification is essential for determining the most appropriate treatment strategy and improving long-term outcomes.

Understanding Risk Categories in Elderly MDS Patients

For patients diagnosed with low- or intermediate-risk MDS, the primary goal of treatment is to improve blood cell production and reduce dependency on transfusions. These individuals often benefit from supportive therapies such as erythropoiesis-stimulating agents, iron chelation when necessary, and nutritional supplementation with key hematopoietic components like vitamin B12 and folate.

The Role of Hypomethylating Agents in MDS Management

One of the most significant advances in treating elderly MDS patients is the use of hypomethylating agents (HMAs), such as azacitidine and decitabine. Unlike traditional chemotherapy, HMAs work by modifying gene expression in abnormal bone marrow cells, helping restore more normal cellular function. This targeted approach has shown remarkable efficacy, particularly in older adults who may not tolerate aggressive treatments well.

Hypomethylating therapy is not only effective in reducing disease progression but also improves quality of life and can extend survival in low- and intermediate-risk patients. Importantly, it carries a more favorable side effect profile compared to conventional chemotherapy, making it a preferred option for frail or comorbid elderly individuals.

Aggressive Treatment Approaches for High-Risk MDS

In contrast, high-risk MDS poses a greater threat due to its potential to rapidly progress to acute myeloid leukemia (AML). For these patients, more intensive interventions are often required. Chemotherapy regimens designed to eliminate malignant clones are commonly used to induce remission and delay transformation.

Curative Potential Through Allogeneic Stem Cell Transplantation

The only potentially curative treatment for high-risk MDS is allogeneic hematopoietic stem cell transplantation (allo-HSCT). While this procedure involves higher risks, especially in older populations, advances in reduced-intensity conditioning regimens have made transplants feasible for selected elderly patients. Careful evaluation of overall health, organ function, and donor availability is critical before proceeding.

Ultimately, treatment decisions should be personalized, incorporating patient age, performance status, genetic profile, and personal preferences. A multidisciplinary approach involving hematologists, oncologists, and supportive care specialists ensures comprehensive management tailored to each individual's needs.