Tratamento da Síndrome Mielodisplásica em idosos: uma revisão de literatura narrativa

Abstract

INTRODUCTION: Myelodysplastic syndrome (MDS) comprises a group of hematological diseases originating from a clonal cell that evolves with morphological, cytogenetic and molecular changes leading to the appearance of cytopenias in the peripheral blood. Its incidence is approximately 2-12/100,000 inhabitants/year in the general population, which increases to 50/100,000 inhabitants/year in the age group above 70 years of age. MDS mainly affects patients from the sixth decade of life, and is rarely found in patients younger than 50 years. OBJECTIVE: To describe and analyze the prevalence of myelodysplastic syndromes in the elderly and the current forms of treatment. METHODOLOGY: This is a Narrative Review, through a bibliographical research using original articles, quantitative and qualitative research, retrospective studies, review articles on the subject and case studies in the last 10 years. RESULTS: A total of 201 studies were analyzed, among which eight studies that dealt with current treatments aimed at elderly people diagnosed with MDS were selected. It was noticed that the treatments still pose a risk to the elderly population, as they are at-risk patients, mainly due to their age and commonly manifesting comorbidities. CONCLUSION: From the analysis of the studies present in this review, it was noticed that the elderly population is the most prone to the manifestation of MDS and that each article reported a different treatment, namely: 1) on the use of epoetin (EPO) alpha; 2) allogeneic hematopoietic stem cell transplantation (HSCT); 3) use of 5-azacytidine (5-aza); 4) use of homoharringtonine (HHT) and cytarabine-based priming induction schemes; 5) use of intravenous busulfan; 6) use of decitabine; 7) use of decitabine-based chemotherapy followed by infusion of haploidentical lymphocytes (ILH) and 8) performance of haploidentical transplantation. It was also seen that the mentioned treatments were effective and safe in patients with MDS and that some authors recommended further research to confirm the results. Regarding the characteristics of the researched articles, we saw that 25% of the articles were from the United States, 25% from Germany and 25% from China; had no publications in 2020; there was a predominance of English in scientific publications; 50% of the studies were obtained from the PubMed database and four retrospective cohort studies were found.