Myelodysplastic syndromes (MDS) are among the most common hematological malignancies in Western countries, with a median age at diagnosis of 74. They are a stem cell disorder characterized by cellular dysplasia, cytopenias, and an increased risk of transformation to acute myeloid leukemia. Disease trajectory is commonly determined by the international and world prognostic scoring systems (International Prognostic Scoring System and the World Health Organization [WHO] classification–based prognostic scoring system) and the WHO classification. Some patients have an indolent disease course, while others experience a rapid deterioration and short overall survival. For many years, the mainstay of therapy was supportive care with blood transfusions and hematopoietic growth factors. Fortunately, novel effective agents including lenalidomide, hypomethylating agents, and oral iron chelators have emerged over the past 5–10 years that improve transfusion dependence and may alter the natural history of the disease. These new therapeutic options offer new hope for individuals with MDS and bolster the role for the investigation of unexplained cytopenias in the older patient.
Key words: myelodysplastic syndrome, erythropoietin, anemia, red blood cell transfusions, stem cell disorder.
Margaret Grant, MD, FRCPC, Geriatrician and Medical Director, Geriatric Assessment Unit, Credit Valley Hospital, Mississauga, ON.
This article focuses on the treatment of orthostatic hypotension (OH) in the elderly. OH is a common problem that can affect an elderly person's function and quality of life. A careful history and physical examination must be done to make an accurate diagnosis and to determine the causes of OH. Treatment should focus on the causes of OH. Both nonpharmacological and pharmacological interventions are reviewed.
Key words: orthostatic hypotension, fludrocortisone, midodrine, octreotide, erythropoietin.
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