Myeloproliferative and myelodysplastic syndromes: the future

The incidence of chronic myeloproliferative diseases and myelodysplastic syndromes could be reduced if relevant environmental factors could be identified and eliminated, but this seems an unlikely prospect for the foreseeable future. More probable is the likelihood that the molecular basis of the chronic myeloproliferative diseases gradually will be elucidated such that specific inhibitory molecules analogous to imatinib may be designed for each disease or each subtype. Combinations of inhibitory molecules may prove especially useful. There is ample scope for improving the clinical results of allogeneic stem cell transplantation, which theoretically could "cure" most patients with myeloproliferative diseases or myelodysplastic syndromes. Reduced-intensity conditioning allogeneic stem cell transplants seem promising. One possibility is identification and exploitation of the basic mechanism underlying the graft-versus-leukemia effect for eradication of minimal residual disease without the need for allografting.