Immunosuppressive therapy in myelodysplastic syndromes: a borrowed therapy in search of the right place

AbstractIntroduction: Myelodysplastic syndromes (MDS) encompass a heterogenous collection of clonal hematopoietic stem cell disorders defined by dysregulated hematopoiesis, peripheral cytopenias, and a risk of leukemic progression. Increasing data support the role of innate and adaptive immune pathways in the pathogenesis and disease course of MDS. The role of immunosuppressive therapy has an established role in the treatment of other hematologic diseases such as aplastic anemia whose pathogenesis is postulated to reflect that of MDS with regards to many aspects of immune activation.Areas covered: This paper discusses the current understanding of immune dysregulation as it pertains to MDS, the clinical experience with immunosuppressive therapy in the management of MDS, as well as future prospects which will likely improve therapeutic options and outcomes for patients with MDS.Expert Commentary: Limited by paucity of high quality data, immunomodulatory and immunosuppressive therapies for the treatment of M...