Juraj Chudej, Juraj Sokol, Ľubica Váleková
The myelodysplastic syndrome (MDS) is a diverse collection of conditions characterized by ineffective haematopoiesis, dysplasia in one or more of the myeloid cell lines and also the proliferation of the blasts in the bone marrow (up to 20 %). 20 % of patients will die during the next 6-9 months after the diagnosis of MDS is done. On the other hand, approximately 20 % of patients survive more than 10-20 years. These are particularly the patients with the diagnosis of the refractory anaemia with the unilineage dysplasia. Due to the heterogeneity of MDS, it is evident that there are several treatment strategies which take into account the patient’s risk level. In the group of patients with low risk the most common kinds of treatment are supportive care, administration of haematopoietic growth factors, chelating, immunosuppressive and immunomodulatory therapy. The supportive care includes the transfusion therapy, the treatment of infectious complications and application of growth factors to improve cytopenia. Patients at high risk should be treated in a similar way as patients with acute myeloid leukemia, including their inclusion in the transplantation program. However, the patient‘s age plays a problematic role, because MDS occurs predominantly in older patients who are unsuitable for transplantation. Anaemia is a major cause of the cardiovascular morbidity and mortality in patients with MDS. There are studies which have consistently shown a strong relationship between lower levels of haemoglobin and worse cardiovascular findings, including the cardiac remodelling, the congestive heart failure, the coronary artery disease, the myocardial infarction, arrhythmias, the cardiac valvular disease, and the cardiovascular mortality.