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Monday, July 12, 2010
David Icke Exposed as a Freemason?
This guy on YouTube Gorilla199 has some very good evidence piling up that David Icke is in fact a Freemason and positioning himself as the savior of the "truth" movement. David Icke's work was a big part of what woke me up to the Illuminati/NWO, but I am also increasingly seeing him as a deep undercover usurper of the alternative research community.
Firstly he was a BBC presenter, a professional soccer goalie, and a Green party politician. Such high level versatility in Media, Sports, and Politics is generally reserved for the super-rich, the well-connected and/or Freemasons, and I thought David Icke was none of the above. How did he get so lucky? Next he comes out and claims to be the Son of God on national TV while wearing a turquoise tracksuit. Whether intentional or not, the forth-coming mass ridicule positioned him as a martyr (Jesus) for the "truth" movement.
His first book "Truth Vibrations" was very New Age and anti-Christian, which is a sentiment that runs throughout his work. He scoffs at New Age philosophies as being the last step before spiritual freedom, meanwhile espousing pretty much every New Age doctrine out there. His book I Am Me, I Am Free clearly has a 666 on the cover and since God is called "I am" in the Bible, the title of this book could be God Me, God Free - i.e. I am God, I am free of any external God. The main tenant of the New Age movement is that we are all our own Gods. Whether that is metaphysically true or not, is up to you to decide, but it is certainly part of the anti-Christian New Age philosophy present in Icke's work.
Now in these videos, Gorilla199 shows David Icke and his ex-wife performing Masonic handshakes and Masonic hand-signs, as well as a very suspicious photo on the Ryde Lodge Isle of Wight (where David Icke actually lives) Masonic website, showing someone who looks very much like David Icke, dressed in complete Masonic garb, with the name W. Bro. David Icke underneath. If that's not enough, the motto of the Ryde Lodge found at the bottom of the website is "Infinite Love is the Only Truth, Everything Else is Illusion" which is the title of one of David Icke's books!
Is this all over-analyzation and coincidence? Are all these findings innocuous? Have a look at some of these videos and leave me comments what you all think about this.
David Icke Crucifies Himself on BBC TV
Is David Icke's Wife a Witch?
David Icke Aliester Crowley Connection
David Icke and Gorilla199 Fight
David Icke Freemasonry Photo Removed From Masonic Website
David Icke Exposed as a Freemason Again?
David Icke and Sherry Shriner Freemasons?
William Cooper Exposes David Icke
ExMI5 Agent Exposes David Icke's Big Lie
31 comments:
I think that if David Icke were a free mason then he wouldn't have to rely on youtube and the internet to get his message across to the public. I know he holds lectures, but it's not like they're covered by the mass media, nor has he ever came up on any major network since the bbc debacle (correct me if I'm wrong) The man that gorilla199 points out as Mr. Icke doesn't even look like him. I'm not an Icke lover. I think he is an interesting man and I've listened to several of his interviews and seminars. He has come a long a way, but I think his success would be far greater if he were a free mason.
- July 13, 2010 at 10:22 AM
Gorilla's "photo" is obviously fake (the one at the mason lodge).
Eric, I am surprised you think all this. From what I've read, Icke is really legit, pushing the envelope with his research.
Reality check bro!!
Icke is badass at soccer and an incredible orator - no wonder he got the gig on BBC and for the Green party. Have you not heard him speak?
-Ken - July 13, 2010 at 2:46 PM
- Eric Dubay said...
If David is controlled and purposely being positioned as a New Age guru/truth movement savior, then I think it must be to fool us during a future event - help lead people away from Christianity and into the one world New Age religion.
Back when Rik Clay was murdered for his research into the NWO's planned fake alien/UFO invasion, everyone on Icke forums was holding up the "suicide" myth... which really shocked me. Does anyone else here frequent the Icke forums? They seem much more free/open than AboveTopSecret.com but I still have the feeling I'm on a controlled site over there. They're constantly moving my posts to sub-forums where they are buried. Also I've tried to contact Mr. Icke for years and never gotten a response - he doesn't have 5 minutes for Eric Dubay? Gorilla199 has challenged him to a debate to clear up all this Masonic stuff, but Icke has simply replied with personal attacks and pictures of laughing animals.
Having said all that, I agree that he is an incredible orator and most of his research really does resonate with me. He starts to lose me, however, with his very literal interpretations of all the reptilian symbolism. Could he purposely be a "turd in the punchbowl" as Alex Jones once said? Mixing a bunch of truth with a couple ridiculous things to discredit anyone who talks about him? I mean, no matter which British person I talk to about Icke, no matter how factual the information I relay to them, they just write me off saying "oh that guy that claims he's the son of God and thinks the Queen is a reptile?"
Has anyone read his new book? For me this is the biggest turd in the punchbowl yet. He says the moon is a hollowed out spaceship with aliens inside that control the human race through mind-control beams! To me this is even less plausible than his reptilian hypothesis, and his credibility and purpose are really coming in to question in my mind. Combine that with all these videos I've linked to, and I'm very much on the fence as to what I think of Mr. Icke.
As I said, he's responsible for waking me up to the NWO, so I'll always be indebted to him for that, but keeping a truly open mind, not just blindly following my "guru," I will continue to consider the possibility that Icke is not exactly what he claims to be. Thanks for the comments so far. What do other people think? - July 13, 2010 at 6:14 PM
"I think that if David Icke were a freemason then he wouldn't have to rely on youtube and the internet to get his message across to the public."
I don't quite buy this argument because David Icke's audience is not the general public. The elite are quite happy to let the sheeple sleep. Icke's audience are the people who are questioning, motivated to research, and not easily discouraged by media disapproval. If he was being interviewed by CNN and Fox news every other day, popping up on Oprah, and splattered all over the media he'd be spotted as an establishment figure straight away. Take a look at David de Rothschild and you'll see what I mean.
Icke is an odd ball, intellectually independent and courageous, mixing open-mindedness with 'serious' book length research; he's hounded and laughed at, yet often perceptive and right on the ball ... he couldn't be a better poster boy for the truth community. He's us, but larger than life and playing pied piper.
Personally I don't trust any 'leaders' from Chomsky the Who Cares About 9/11? to Michael star of orion. I especially don't trust voodoo fellas like Icke. Normal people don't drink champagne with reptilian shape shifters, receive messages from angles, or for that matter fluently understand ancient tribal languages. We do know skyscrapers don't collapse at free fall when they weren't even hit by a plane, we do know police brutality and the rising big brother state when we see it, and we do know the elite is a closed globalist club of sociopaths who wouldn't mind exchanging six billion people for a dozen robots and a new Eden.
Did I go off on a rant? I'll stop in a mo. Don't trust leaders. Be very careful about what you believe, and consider how certain beliefs may affect your actions. I for one don't have a clue how to deal with moon aliens and mind control beams. Mr Icke I can make a cup of tea and hand out a DVD. Thanks a lot. - July 14, 2010 at 1:04 AM
Eric,way before this hoopla started between them, I posted a question for David Icke. In a thread entitled "ask David Icke anything" or something to that effect on his site.
I wanted to know what David Icke thought of gorilla199's video of the wheat and the tares.
I thought it fit nicely with his reptilian ideas, but my thread was removed. So yeah, I do get a controlled vibe over there.
On a side note, I was watching an interview with michael tsarion and
jordan maxwell. I don't remember
who the interviewer was but he asked them if they belived in Jesus.
Jordan said I'll handle this" and gave a long winded answer that basically said No.
While all these speakers are thought provoking and entertaining,they have a subtle and sometimes not so subtle anti Jesus message.
So,beware of false prophets. - July 14, 2010 at 1:26 AM
- Eric Dubay said...
Excellent comments Anonymous! I agree with all the points you made. Thanks for the contribution.
- July 14, 2010 at 3:04 AM
Hi Eric, there are some things I left out of my last post.
One day while channel surfing I saw Michael Tsarion being interviewed
by Bill O Riley on FOX. I didn't see the whole interview but I stopped to watch it and thought
Oh, Bill is going to berate, shout down and demean Michael into oblivion. He did just the opposite. Instead, he treated him with great respect.
Which I thought was odd or telling if you like.
Anyway back to Ike. The reason why I wanted to know what he thought about Gorila199's video on the wheat & the tares was because two of them revealed themselves to me. More specifically, I saw the whites of their eyes change from white to yellow & with a vertical black slit in the middle.
Even as Anonymous on the internet, I don't want to get into the specifics of how & why they chose to reveal themselves to me.
I don't know if these are the reptilians that David talks about or some sort parasitic alien race that use other beings as hosts ala stargate, aka the "Goa'uld" but
I saw something otherworldly.
So, from my own personal experience, I KNOW there are people that look like us but are not like us, or as the bible refers to them as tares. Jesus' Parable of Wheat & Tares Matthew 13: 24-30, 36-43 - July 14, 2010 at 10:33 AM
- Unknown said...
I think the 'turd in the punchbowl' are the reformed satanists claiming the bible is the Truth. It is much more provable.
And what are other interpretations for the multitudes of serpent gods, half human half serpents, and humans being consumed by serpents? And why does every culture across the globe have the same ancient deities?
I have yet to hear a better explanation. - July 15, 2010 at 7:29 AM
While its quite possible that Icke is out to deceive us, there are a few lines of reasoning in post that i find pretty disappointing, as your blog generally is of a very high standard.
Nothing in this post that I saw dealt with why Icke's content is incorrect or misleading. There are some references to the moon spaceship and reptilians but all that is said against it is that these are crazy ideas. No argument against the ideas, just labeling them as crazy. This is the same treatment mainstream media give to 911 truthers.
Gorilla119 is clearly motivated by his defense of Christianity when seeking to discredit Icke, this immediately makes me skeptical. Its funny to me how Icke critises so many things but its always the Christians who fight to defend themselves by discrediting. It was the same Zeitgeist.
The 'false prophets' scripture quoting is nothing more than fear mongering. There is no argument there for why he is a false prophet just attaching the label.
Following a 'leader' like Icke (or anyone for that matter) without distilling their content and coming to your own views is a bad move - as i'm sure we all agree. But discrediting someone without focusing on their content is the other side of the same coin. I'm not sure yet about the reptilians or the spaceship moon, but i certainly havn't seen enough to write them off.
I'm keen to know whether Icke is ligit or not, so thanks for posting, however I don't think there is anything here that discredits him. The photo is a fake, and scripture doesn't scare me off. - July 15, 2010 at 2:57 PM
"There are some references to the moon spaceship and reptilians but all that is said against it is that these are crazy ideas. No argument against the ideas, just labeling them as crazy. This is the same treatment mainstream media give to 911 truthers."
There is one big difference. There is a lot verifiable evidence to back the claims made by the 9/11 truth movement. There is no way for any normal researcher to back up claims concerning reptilians and moon aliens. Evidence is a big thing when you're look to uncover the truth. - July 17, 2010 at 5:01 AM
This could be true, but the information that he puts (let put) in his website is far beyond freemason control....
He knows that het can't speak the real truth without been completely banned, so he speaks to the limit. - July 18, 2010 at 7:17 AM
- Fernando said...
hyde lodge 698 site is down due to a hack!!! wtf....I just wanted to see to check it out for my self!
- July 21, 2010 at 12:37 AM
This gut, gorilla199, is very suspect in my opinion.
I left a comment on youtube regarding his video on David's moon theory, just explaining that the photo he used as "evidence" that David was a Freemason was actually photoshopped (quite badly)and had been debunked by a user over at the Icke forum. He had simply superimposed a picture of David's head over an actual Freemason's head. The two separate pictures he had used were even found on Google images quite easily.
He then set up a blog that was supposedly the website for a Masonic Lodge on the Isle of Wight, another fake.
Gorilla199 promptly deleted my comment from youtube and then blocked me. The comment I left was not insulting or derogatory in any way, he deleted it just because what I said was the truth. He didn't even respond or defend himself, just deleted, blocked.
He has a very strange obsession with discrediting Icke and personally I wouldn't trust anything he says, he has already been proven to be a liar. - August 22, 2010 at 1:50 PM
Were david icke revealing the truth, the whole truth, and nothing but the truth it is highly unlikely that he would be allowed to continue doing what he is doing. Either wittingly or unwittingly he has to be helping so called agenda, even if it is only to discredit various religions, after which he may be bumped off.
However, it is my belief that all the extant religions were little more than the mystery schools human cattle management programs over the past few millenia. The old myth of the one god for the old age of picies is to be replaced by the new myth of oneness for the new age of aquarius. This will be the new human cattle management system for the next couple of millenia. First however they wish to play off their obiedient flocks against one another, muslim v christian.
It never ceases to amaze me how people can accept that everything they have been taught about the way the world works is wrong, yet still cling desperately to whatever religion the system has taught them. I guess it's just one step too far for most people.
The ancestors, ideological or biological, of the same people running the planet wrote the very books and scriptures people feel will save them from the coming storm. We have a long way to go yet people. - September 12, 2010 at 7:27 PM
The 666 hand gesture is only part of the picture.
Look again at that picture and you will see the answer to the question you pose is answered by Ickey himself.
Icke is without doubt a Free Mason as this image suggests BUT the first series of Free Mason images, the ones of the Free Masons all lined up in their Lodge was not worthy of publication on this blog.
Icke was a resident viewer of my recently demised exblog. A blog dedicated to the Free Mason involvemnt in the coverup of the McCanns concerning the death of Madeleine McCann. Icke would visit my site as much as 3 or 4 times a day...every day.
So intrigued was I about his 'looking in' I even asked him if he would like to contribute but to date he has not seen fit to reply to my request.
The area around Rothley is also reknowned as the home of Free Masons, Templar Free Masons, one of which is Gerry McCann whom they count amongst their number.
The Rothley Priory meets at the Rothley Court Hotel. This is a venue selected by Clarence Mitchell, also a Free Mason, to play host for most of the McCannns recent, and not so recent press conferences.
THENTHEREWERE4 - October 11, 2010 at 6:27 AM
I don't know if he's a mason or some kind of mind control slave, but I believe his purpose is to deceive open minded people and to discredit actual truths.
- October 13, 2010 at 3:43 PM
david ickes 'masonic hand sign' is actually lack of movement in his hand due to severe arthritis...
- July 31, 2011 at 3:53 PM
- Eric Dubay said...
david ickes 'masonic hand sign' is actually lack of movement in his hand due to severe arthritis...
So he says. What about the picture of his wife, does she have arthritis too? - July 31, 2011 at 5:45 PM
I laughed so hard when I just found this website. do you know anything about this gorilla guy?? lol
Check this out
You might want to check some of his own personal photos at
it also clearly says on the BBC News article that he is SERIOUSLY MENTALLY ILL.
And there is A LOT more in the way of video of him that will just make you laugh yourself shitless. I just wanna leave you to find that for your yourself. Stop being so naive - do your due dilligence on people before you start 'following' them. check out your sources first before making a website up claiming your belief in their words. FFS this guy is a pyscho.
Also - did you realise that a british masonic lodge would not use a BLOGGER website? that site is obviously a hoax... wake up dude! - October 30, 2011 at 12:57 PM
At the end of the day, david icke has handed out much more REAL information that IS needed in these dark times than any of the churchs and religions have EVER offered!!- speaks for itself. Lets use our common sense. Freemason or not, the information is more spot on and realistic to the awareness we need to pull our finger out and stand up for whats the real deal here! - waiting for a 'saviour' just doesn't cut it for me with humans behaviour. What sit back and hope it'll be ok!? Continue to CONDONE and play with the demons because of the fear of loosing your comforts? Because unless we all pull out inc. religions which are sitting on billions your still all up in arms with the vile creature, so good luck for your conscience. If the power is within you to change even the slightest thing for the good, it is YOUR responsibility to do so and NOT pass the blumin buck to a 'saviour' to do the job for you. You are all part of the creator, so do the best for him and be his soldiers at least!- stop taking from life and being cowards. The bible was merged with paganism via constantine, funny thing is, the amount of times its been played with since then, still doesn't make people question the obvious!? lol Read between the lines people.
- January 2, 2012 at 11:54 AM
Fake ... You only have to notice that there medals are on the wrong side because someone has flipped the original photo. A very bad photo-shop .... Also if you look on google you will find the real photo and you will see a very clear image of someone who is not David ... .Good try .. But a BIG FAIL.
- April 14, 2012 at 8:02 AM
i don't trust him,(sorry for my bad english in proceed) he refers to be written in Bible gods,but that aint the truth,in Bible is written son of God,and refers to an fallen angels(about 1/3 of all angels in heaven) and they felt with lucifer
- May 18, 2012 at 10:41 AM
David icke has been discredited many many times in the past,and by his own words and books.Please people do some homework,his own theories have changed from his first books when he reckoned he was chanelling information.
Ask yourselves this,why are his books so expensive? If this man wanted to 'share' his information then why are his books so expensive not to mention his seminars.
His book 911 and alice in wonderland was simply an excercise in plagarism,everything in the book was taken direct from the web.
The man is a fraud who makes tons of money from his bullshit,and yes it makes perfect sense that he is a mason,he is just the same as alex jones,government stooges,dis-information experts,everyone do your homework read ickes early books and you can easilynspot the lies in them that he now tries to hide and distance himself from - October 13, 2012 at 2:51 PM
Aside from the christian stance that gorilla has...i think you all should check out his earlier videos ...they have alot of information regarding latin translations and architecture. ...the guy obviously does his HOMEWORK...maybe this jesus guy was an aside of warnings of the NWO ..today's christians are obviously a farce ..the nostics were let out of alot of scripture...but look at the quotations of what today's anarchists say...its pretty dead on to what "jesus" said. and im non-religious.
- November 10, 2012 at 10:19 PM
- Chunk said...
Google "Ryde lodge 698 Icke"
David Ickes name comes up on the new ryde lodge websites search??
Also google:
David icke is a freemason phone call
Hello?? David Icke is and will always be afreemason - December 18, 2012 at 8:38 AM
Eric, last night I read your convinincing piece about religion being nothing but rehashed and literalized Egyptian sun god worship. Today, it appears (to me) that you agree with modern Christianity, in writing about Icke. Is this true or am I missing something?? Thanks, in advance, should you decided to briefly respond and help me to understand.
- July 22, 2013 at 9:05 AM
- Eric Dubay said...
Hey Anonymous, thanks for the comment. Christianity is absolutely a rehashing of Egyptian sun worship under a new name. I'm not Christian, but my entire family is. I think there are plenty of good people and good ideas in Christianity, but that is trumped by it's evil history and brainwashing. Peace
- July 22, 2013 at 6:40 PM
- Unknown said...
You're wrong about Christanity and the "Sun God"....there's much more to the history of that movement than similarities to pagan Gods( "Zeitgeist" may well be disinfo too)...Being against Christianity is a very big mistake...that's what Jews have been trying to do through various methods..don't be part of a movement that will allow outsiders to destroy our culture and our values...both intrinsically tied to Christianity. Christanity is NOT just a religion..it's the history of western civilization and any success it may have had comes from the cooperative, loving, family oriented, non-exploitive zeitgeist that Christanity brings. That it has been divided, attacked and ridiculed by the enemies of freedom and peace is not a coincidence. Kill Christanity ad we kill ourselves. And that's the way it's going. You needn't believe in the spiritual part of it, to be a Christian..or to appreciate it's crucial part in our civilized advancement...
- December 22, 2013 at 7:47 AM
- Unknown said...
I'd also point out that the "evil" things that you are associating with Christianity actually had nothing to do with Christianity...even if done by people calling themselves Christians...there are a lot of people who have used the Christian title to do evil and bring blasphemy on to the Church..there is only one true Church...it can never be evil...only mankind can do evil..
- December 22, 2013 at 7:53 AM
I am me I am Free. Jewish Gematria. = Mason.
- June 30, 2021 at 4:49 PM
The main thing which no-one is addressing is that Icke always leads us to a spiritually devastating conclusion. He says that we can all achieve unlimited consciousness. This is wrong. Only God has unlimited consciousness. Granted, we all have tremendous potentials in our consciousness, but only God has unlimited consciousness. The bottom line is that ICKE is profoundly envious of God.
- November 16, 2021 at 6:12 AM


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The key to understanding your company's requirements is to first ascertain its size. The narrative reporting requirements become more onerous as a company increases in size.
The current size limits are as follows:
A company needs to meet two out of three of the above criteria for two consecutive years to qualify as a micro, small or medium-sized company, unless it is the first year of the company's existence, in which case only that year has to be considered. The turnover limit is adjusted if the financial year is longer or shorter than twelve months.
There are certain exclusions from the above size limits which are set out in the Companies Act 2006. In addition special rules apply to parent undertakings which need to be taken into account.
Companies that meet the micro-entity size criteria, and have opted to prepare their annual report in accordance with the micro-entity provisions, have no narrative reporting requirements due to the simplified arrangements that exist for such companies.
In practice many companies, despite meeting the size criteria, find the reporting requirements for micro-entities inappropriate for their needs, and voluntarily choose to prepare their annual report using the small-entity provisions instead. In such circumstances they will be subject to the narrative reporting requirements applicable to small entities.
Companies that are able to and choose to adopt the small-entity reporting provisions are required to include a directors' report as part of their annual report that is distributed to the company's members. Note though that the directors' report does not need to be included as part of the annual report that is filed at Companies House: it (and the profit and loss account) can currently be removed from the annual report in a process commonly known as filleting.
The directors' report of a small company is required to include the following:
Although not required, many small companies will also provide a brief description of the company's trading activity.
A statement that advantage has been taken of the small companies exemptions in preparing the directors' report is also required, which is presented immediately above the signature of the director or secretary who is signing the report on behalf of the board.
Both medium and large size entities have considerably more onerous narrative reporting requirements when compared to small entities, and there is no exemption available to them when filing their annual report with Companies House.
The most significant difference is the need to incorporate a strategic report as part of the annual report. There are also additional requirements for the directors' report that will need to be addressed.
The reporting requirements are in the process of being enhanced, with additional disclosures being introduced. Before these are considered though let's examine the existing narrative reporting requirements.
For a private limited company the strategic report should contain the following:
For parent companies preparing consolidated accounts the strategic report is required to consider the group's performance and not just that of the company itself.
A medium or large company is required to include in its directors' report all of the matters that a small company has to include, but also has the following additional requirements:
Often it will make sense for the company to present information required to be included within the directors' report as part of the strategic report. This is permitted, provided that there is a clear cross reference to the disclosures that have been included as part of the strategic report within the directors' report.
Most small companies will be able to take advantage of audit exemption, but medium and large companies will be subject to the requirement to have their accounts audited. For those companies that are required to have their accounts audited, or choose to do so voluntarily, there are two additional requirements:
These statements are often included as part of the directors' report. The statement of the directors' responsibility for the preparation of the financial statements can be presented separately if desired.
The Companies (Miscellaneous Reporting) Regulations 2018 take effect for accounting periods commencing on or after 1 January 2019.
These regulations only make one change to the strategic report, and this is only applicable to large companies. A new requirement has been introduced to include a statement of how the directors have complied with their duty to have regard to the matters set out in section 172 (1)(a)-(f) of the Companies Act 2006. This refers to the requirement that a director of a company must act in the way he or she considers, in good faith, would be most likely to promote the success of the company for the benefit of its members as a whole, and in doing so have regard (amongst other matters) to:
This disclosure will need to reflect the issues, factors and stakeholders the directors consider relevant to their decision making, the main methods used to engage with stakeholders and understand the issues to which they must have regard, and information on the effect of that regard on the company's decisions and strategies during the financial year.
Note that this statement will also need to be published on the company's website.
The regulations also have the following implications for the directors' report:
As part of the need to address climate change and encourage companies to consider their responsibilities towards the environment new regulations have been introduced that apply to large companies for periods commencing on or after 1 April 2019 that require them to include disclosures in their directors' report on environmental matters.
For low energy users, that is a large company which has consumed 40MWh or less of energy in the UK (including offshore areas), the directors' report merely needs to state that energy and carbon information is not being disclosed as it is a low energy user. In assessing whether the 40MWh threshold is met large companies must consider all the energy from gas, electricity and transport fuel usage. For parent companies the energy consumption of the parent and its subsidiaries must not exceed 40MWh if it is to qualify as a low energy user.
Large companies that do not qualify as low energy users will need to disclose the following:
Although this new requirement only applies to large companies (and limited liability partnerships (LLPs)) other entities are encouraged to consider whether it would be helpful to the users of their financial statements to also make these disclosures. For LLPs, the disclosures are presented in an 'Energy and Carbon Report'.
Clearly these disclosure requirements are going to prove challenging to many companies. The Government had produced detailed guidance to assist companies meet their obligations.
If you live in the East Sussex area we, Holland Harper, will be very pleased to discuss the impact on your company of the narrative reporting requirements outlined above. If you would like to discuss these issues in more detail, please contact us.


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Baked chicken breast topped with skinny basil pesto[1], tomatoes, mozzarella and parmesan cheese. Quick and easy, serve this with pasta for a complete meal.
This is a great way to use up your end-of-summer basil. If it's still warm out, you can also do this on the grill.
As the weather turns cooler, I've been making and freezing skinny pesto[2] in small batches to keep on hand throughout the year. You can freeze them in ice cube trays and measure them out or use small containers like I did here. Enjoy!
Skinny Chicken Pesto Bake
Servings: 4 • Size: 1 piece • Old Points: 6 pts • Points+: 6 pts
Calories: 236 • Fat: 11.5 g • Carbs: 2.5 g • Fiber: 0.5 g • Protein: 28.5 g • Sugar: 0 g
Sodium: 491 mg (without salt)
- 2 (16 oz total) boneless, skinless chicken breasts
- salt and fresh pepper to taste
- 4 tsp Skinny Basil Pesto[3]
- 1 medium tomatoes, sliced thin
- 6 tbsp (1.5 oz) shredded reduced fat mozzarella cheese
- 2 tsp grated parmesan cheese
Wash chicken and dry with a paper towel. Slice chicken breast horizontally to create 4 thinner cutlets. Season lightly with salt and fresh pepper.
Preheat the oven to 400° F. Line baking sheet with foil or parchment for easy clean-up.
Place the chicken on prepared baking sheet. Spread 1 tsp of skinny pesto over each piece of chicken.
Bake for 15 minutes or until chicken is no longer pink in center. Remove from oven; top with tomatoes, mozzarella and parmesan cheese. Bake for an additional 3 to 5 minutes or until cheese is melted.
To Grill: Grill chicken over medium flame on both sides until cooked through in the center. Lower flame, top chicken with tomatoes and cheese, and close grill until cheese melts.
- ^ skinny basil pesto (www.gordon-ramsay-recipe.com)
- ^ skinny pesto (www.gordon-ramsay-recipe.com)
- ^ Skinny Basil Pesto (www.gordon-ramsay-recipe.com)


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Myelodysplastic Syndromes Treatment (PDQ®)–Health Professional Version
General Information About Myelodysplastic Syndromes (MDS)
Incidence and Mortality
The MDS are a collection of myeloid malignancies characterized by one or more peripheral blood cytopenias. MDS are diagnosed in slightly more than 10,000 people in the United States yearly, for an annual age-adjusted incidence rate of approximately 4.4 to 4.6 cases per 100,000 people.[1] They are more common in men and White individuals. The syndromes may arise de novo or secondarily after treatment with chemotherapy and/or radiation therapy for other cancers or, rarely, after environmental exposures.
Prognosis is directly related to the number of bone marrow blast cells, to certain cytogenetic abnormalities, and to the amount of peripheral blood cytopenias. By convention, MDS are reclassified as acute myeloid leukemia (AML) with myelodysplastic features when blood or bone marrow blasts reach or exceed 20%. Many patients succumb to complications of cytopenias before progression to this stage. For more information, see the Pathological and Prognostic Systems for MDS section. The acute leukemic phase is less responsive to chemotherapy than is de novo AML.
MDS are characterized by abnormal bone marrow and blood cell morphology. Megaloblastoid erythroid hyperplasia with macrocytic anemia, associated with normal vitamin B12 and folate levels, is frequently observed. Circulating granulocytes are often hypogranular or hypergranular and may display the acquired pseudo-Pelger-Huët abnormality. Early, abnormal myeloid progenitors are identified in the marrow in varying percentages. Abnormally small megakaryocytes (micromegakaryocytes) may be seen in the marrow, and hypogranular or giant platelets may appear in the blood.
Clinical Features
MDS occur predominantly in older patients (usually older than 60 years), with a median age at diagnosis of approximately 70 years,[2] although patients as young as 2 years have been reported.[3] Anemia, bleeding, easy bruising, and fatigue are common initial findings. For more information, see Fatigue. Splenomegaly or hepatosplenomegaly may indicate an overlapping myeloproliferative neoplasm. Approximately 50% of patients have a detectable cytogenetic abnormality, most commonly a deletion of all or part of chromosome 5 or 7, or trisomy 8. Single-nucleotide polymorphism array technology may increase the detection of genetic abnormalities to 80%.[4,5] Although the bone marrow is usually hypercellular at diagnosis, 10% of patients present with a hypoplastic bone marrow.[6] Hypoplastic myelodysplastic patients tend to have profound cytopenias and may respond more frequently to immunosuppressive therapy.
Risk Factors
Approximately 90% of MDS cases occur de novo with no identifiable cause. Potential environmental risk factors for developing MDS include exposure to the following:[7,8]
- Tobacco smoke.
- Ionizing radiation.
- Organic chemicals (e.g., benzene, toluene, xylene, and chloramphenicol).
- Heavy metals.
- Herbicides.
- Pesticides.
- Fertilizers.
- Stone and cereal dusts.
- Exhaust gases.
- Nitro-organic explosives.
- Petroleum and diesel derivatives.
- Ma X, Does M, Raza A, et al.: Myelodysplastic syndromes: incidence and survival in the United States. Cancer 109 (8): 1536-42, 2007. [PUBMED Abstract]
- Sekeres MA, Schoonen WM, Kantarjian H, et al.: Characteristics of US patients with myelodysplastic syndromes: results of six cross-sectional physician surveys. J Natl Cancer Inst 100 (21): 1542-51, 2008. [PUBMED Abstract]
- Tuncer MA, Pagliuca A, Hicsonmez G, et al.: Primary myelodysplastic syndrome in children: the clinical experience in 33 cases. Br J Haematol 82 (2): 347-53, 1992. [PUBMED Abstract]
- Gyger M, Infante-Rivard C, D'Angelo G, et al.: Prognostic value of clonal chromosomal abnormalities in patients with primary myelodysplastic syndromes. Am J Hematol 28 (1): 13-20, 1988. [PUBMED Abstract]
- Tiu RV, Gondek LP, O'Keefe CL, et al.: Prognostic impact of SNP array karyotyping in myelodysplastic syndromes and related myeloid malignancies. Blood 117 (17): 4552-60, 2011. [PUBMED Abstract]
- Nand S, Godwin JE: Hypoplastic myelodysplastic syndrome. Cancer 62 (5): 958-64, 1988. [PUBMED Abstract]
- Du Y, Fryzek J, Sekeres MA, et al.: Smoking and alcohol intake as risk factors for myelodysplastic syndromes (MDS). Leuk Res 34 (1): 1-5, 2010. [PUBMED Abstract]
- Strom SS, Gu Y, Gruschkus SK, et al.: Risk factors of myelodysplastic syndromes: a case-control study. Leukemia 19 (11): 1912-8, 2005. [PUBMED Abstract]
Pathological and Prognostic Systems for MDS
Myelodysplastic syndromes (MDS) are classified according to features of cellular morphology, etiology, and clinical presentation. The morphological classification of MDS is largely based on the percent of myeloblasts in the bone marrow and blood, the type and degree of myeloid dysplasia, and the presence of ring sideroblasts.[1] The clinical classification of the MDS depends on whether there is an identifiable etiology and whether the MDS has been treated previously.
Pathological Systems
The World Health Organization (WHO) classification [2] has supplanted the historic French-American-British (FAB) classification,[1] as shown in Table 1.
AML = acute myeloid leukemia; FAB = French-American-British classification scheme; MDS = myelodysplastic syndromes; WHO = World Health Organization. | |
Myelodysplastic Syndromes | |
Refractory anemia. | Refractory anemia. |
Refractory cytopenia with multilineage dysplasia. Refractory cytopenia with unilineage dysplasia. | |
Refractory anemia with ring sideroblasts. | Refractory anemia with ring sideroblasts. |
Refractory anemia with excess blasts. | Refractory anemia with excess blasts -1 and -2. |
Myelodysplastic syndrome, unclassifiable. | |
Myelodysplastic syndrome associated with del(5q). | |
Reclassified from MDS to: | |
Refractory anemia with excess blasts in transformation. | Acute myeloid leukemia identified as AML with multilineage dysplasia following a myelodysplastic syndrome. |
Chronic myelomonocytic leukemia. | Myelodysplastic and myeloproliferative diseases. |
MDS cellular types and subtypes in either cellular classification scheme have different degrees of disordered hematopoiesis, frequencies of transformation to acute leukemia, and prognoses.
Refractory anemia (RA)
In patients with RA, the myeloid and megakaryocytic series in the bone marrow appear normal, but megaloblastoid erythroid hyperplasia is present. Dysplasia is usually minimal. Marrow blasts are less than 5%, and no peripheral blasts are present. Macrocytic anemia with reticulocytopenia is present in the blood. Transformation to acute leukemia is rare, and median survival varies from 2 years to 5 years in most series. RA accounts for 20% to 30% of all patients with MDS.
Refractory anemia with ring sideroblasts (RARS)
In patients with RARS, the blood and marrow are identical to those in patients with RA, except that at least 15% of marrow red cell precursors are ring sideroblasts. Approximately 10% to 12% of patients present with this type, and prognosis is identical to that of RA. Approximately 1% to 2% of RARS evolve to acute myeloid leukemia (AML).
Refractory anemia with excess blasts (RAEB)
In patients with RAEB, there is significant evidence of disordered myelopoiesis and megakaryocytopoiesis in addition to abnormal erythropoiesis. Because of differences in prognosis related to progression to a frank AML, this cellular classification is composed of two categories: RAEB-1 and RAEB-2. Combined, the two categories account for approximately 40% of all patients with MDS. RAEB-1 is characterized by 5% to 9% blasts in the bone marrow and less than 5% blasts in the blood. Approximately 25% of cases of RAEB-1 progress to AML. Median survival is approximately 18 months. RAEB-2 is characterized by 10% to 19% blasts in the bone marrow. Approximately 33% of cases of RAEB-2 progress to AML. Median survival for RAEB-2 is approximately 10 months.
Refractory cytopenia with multilineage dysplasia (RCMD)
In patients with RCMD, bicytopenia or pancytopenia is present. In addition, dysplastic changes are present in 10% or more of the cells in two or more myeloid cell lines. There are less than 1% blasts in the blood and less than 5% blasts in the bone marrow. Auer rods are not present. Monocytes in the blood are less than 1 × 109. RCMD accounts for approximately 24% of cases of MDS. The frequency of evolution to acute leukemia is 11%. The overall median survival is 33 months. Refractory cytopenia with multilineage dysplasia and ring sideroblasts (RCMD-RS) represents another category of RCMD. In RCMD-RS, features of RCMD are present, and more than 15% of erythroid precursors in the bone marrow are ring sideroblasts. RCMD-RS accounts for approximately 15% of cases of MDS. Survival in RCMD-RS is similar to that in primary RCMD.
Refractory cytopenia with unilineage dysplasia (RCUD)
In patients with RCUD, a single cytopenia is present, involving either erythrocytes, neutrophils, or platelets. In addition, dysplastic changes are present in 10% or more of the cells in two or more myeloid cell lines. There are less than 1% blasts in the blood and less than 5% blasts in the bone marrow. Auer rods are not present. Monocytes in the blood are less than 1 × 109.
Unclassifiable myelodysplastic syndrome (MDS-U)
The cellular subtype MDS-U lacks findings appropriate for classification as RA, RARS, RCMD, or RAEB. Blasts in the blood and bone marrow are not increased.
Myelodysplastic syndrome associated with an isolated del(5q) chromosome abnormality
This MDS cellular subtype, the 5q- syndrome, is associated with an isolated del(5q) cytogenetic abnormality. Blasts in both blood and bone marrow are less than 5%. This subtype is associated with a long survival. Karyotypic evolution is uncommon. Additional cytogenetic abnormalities may be associated with a more aggressive MDS cellular subtype or may evolve to AML.
Therapy-related myeloid neoplasms
The latest version of the WHO pathological classification system identifies patients with therapy-related MDS or AML and places them in the same category as "therapy-related myeloid neoplasms." This group of disorders evolves in patients who were previously treated with chemotherapy or radiation therapy for other cancers and in whom there is a clinical suspicion that the prior therapy caused the myeloid neoplasm. Classic chemotherapy agents associated with these disorders include alkylating agents, topoisomerase inhibitors, and purine nucleoside analogues.
Chronic myelomonocytic leukemia (CMML)
Although previously classified with the myelodysplastic syndromes, CMML is now assigned to a group of overlap myelodysplastic/myeloproliferative neoplasms. For more information, see Myelodysplastic/ Myeloproliferative Neoplasms Treatment.
Prognostic Scoring Systems
A variety of pathological and risk classification systems have been developed to predict the overall survival of patients with MDS and the evolution from MDS to AML. Major prognostic classification systems include the International Prognostic Scoring System (IPSS), revised as the IPSS-R;[3] the WHO Prognostic Scoring System (WPSS); and the MD Anderson Cancer Center Prognostic Scoring Systems.[4,5] Clinical variables in these systems have included bone marrow and blood myeloblast percentage, specific cytopenias, transfusion requirements, age, performance status, and bone marrow cytogenetic abnormalities.
The IPSS incorporates bone marrow blast percentage, number of peripheral blood cytopenias, and cytogenetic risk group.
Compared with the IPSS, the IPSS-R updates and gives greater weight to cytogenetic abnormalities and severity of cytopenias, while reassigning the weighting for blast percentages.[3]
In contrast to the IPSS and IPSS-R, which should be applied only at the time of diagnosis, the WPSS is dynamic, meaning that patients can be reassigned categories as their disease progresses.
MD Anderson
The MD Anderson Cancer Center has published two prognostic scoring systems, one of which is focused on lower-risk patients.[4,5]
- Bennett JM, Catovsky D, Daniel MT, et al.: Proposals for the classification of the myelodysplastic syndromes. Br J Haematol 51 (2): 189-99, 1982. [PUBMED Abstract]
- Vardiman JW, Thiele J, Arber DA, et al.: The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood 114 (5): 937-51, 2009. [PUBMED Abstract]
- Greenberg PL, Tuechler H, Schanz J, et al.: Revised international prognostic scoring system for myelodysplastic syndromes. Blood 120 (12): 2454-65, 2012. [PUBMED Abstract]
- Garcia-Manero G, Shan J, Faderl S, et al.: A prognostic score for patients with lower risk myelodysplastic syndrome. Leukemia 22 (3): 538-43, 2008. [PUBMED Abstract]
- Kantarjian H, O'Brien S, Ravandi F, et al.: Proposal for a new risk model in myelodysplastic syndrome that accounts for events not considered in the original International Prognostic Scoring System. Cancer 113 (6): 1351-61, 2008. [PUBMED Abstract]
Treatment of MDS
Therapies for myelodysplastic syndromes (MDS) are initiated in patients with a shorter predicted survival or in patients with clinically significant cytopenias. The impact of most MDS therapies on survival remains unproven.
Treatment options:
Supportive Care
The mainstay of treatment for MDS has traditionally been supportive care, particularly for patients with symptomatic cytopenias or who are at high risk of infection or bleeding.[1,2] Transfusions are reserved for the treatment of active bleeding; many centers offer prophylactic platelet transfusions for patients with platelet counts lower than 10,000/mm3. Anemia should be treated with red-cell transfusions to avoid symptoms. For more information, see Fatigue.
No prospective trials have demonstrated the benefit of prophylactic use of myeloid growth factors in asymptomatic neutropenic MDS patients. Similarly, the use of prophylactic antibiotics in such patients is of uncertain benefit. While appropriate use of antibiotics in febrile patients is standard clinical practice, the benefit of myeloid growth factors in such settings is unknown.
The use of erythropoiesis-stimulating agents (ESAs) may improve anemia. The likelihood of response to exogenous erythropoietin administration depends on the pretreatment serum erythropoietin level and baseline transfusion needs.
A meta-analysis summarized the data on erythropoietin in 205 patients with MDS from 17 studies. Responses were most likely in patients who were anemic but who did not yet require a transfusion, patients who did not have ring sideroblasts, and patients who had a serum erythropoietin level lower than 200 IU/L.[3] Effective treatment requires substantially higher doses of erythropoietin than are used for other indications; the minimum effective dose studied is 60,000 IU per week.[4] The use of high-dose darbepoetin (300 µg/dose weekly or 500 µg/dose every 2–3 weeks) has been reported to produce a major erythroid response rate of almost 50% in patients whose endogenous erythropoietin level was lower than 500 mIU/mL.[5,6] Most studies discontinued ESAs in patients who failed to show hematologic improvement after 3 to 4 months of therapy. Average response duration is approximately 2 years.[7]
One decision model found that the likelihood of responding to growth factors was higher in patients with a low serum erythropoietin level (<500 IU/L) and low transfusion needs (<2 units of packed red blood cells every month), but growth factors were rarely effective in patients with a high erythropoietin level and high transfusion needs.[8] Some patients with poor response to erythropoietin alone may have improved response with the addition of low doses of granulocyte colony-stimulating factor (G-CSF) (0.5–1.0 µg/kg/day).[9-11] Rates of response to the combination treatment vary with classification, with responses more likely in patients with refractory anemia and ring sideroblasts (RARS) and less likely in patients with excess blasts.[7] Patients with RARS are unlikely to respond to erythropoietin alone.[3]
The availability of the oral iron-chelating agent deferasirox has led to its widespread use in patients with MDS. While some consensus panels advocate prophylactic iron chelation in patients with ongoing transfusion needs and substantial transfusion history, the impact of iron chelation on survival and disease progression is unknown.[12]
Disease-Modifying Agents
Lower-risk patients (conventionally defined as International Prognostic Scoring System (IPSS) low-risk and intermediate-1–risk groups) who have failed to respond or have ceased responding to ESAs may be treated with one of several disease-modifying agents. The impact of this practice on survival in lower-risk patients is unknown. Whether these drugs should be used following an ESA failure or as up-front therapy has never been determined. In contrast, in higher-risk patients, azacitidine has been shown to improve survival. For more information, see the DNA methyltransferase inhibitors section.
The U.S. Food and Drug Administration (FDA) approved lenalidomide for the treatment of lower-risk, transfusion-dependent patients with MDS who harbor a del(5q) cytogenic abnormality. In a phase II registration study of 148 transfusion-dependent low-risk and intermediate-1–risk patients with del(5q) chromosomal abnormalities (alone, or associated with other abnormalities), lenalidomide induced transfusion independence in 67%, with a median time to response of 4 to 5 weeks.[13] The median duration of transfusion independence had not been reached after a median of 104 weeks of follow-up. Of 62 evaluable patients, 38 patients developed complete cytogenetic remission.
Lenalidomide administration is limited by dose-limiting neutropenia and thrombocytopenia.[14][Level of evidence C3] Treatment-related thrombocytopenia also correlated with cytogenetic responses, emphasizing the importance of successful suppression of the del(5q) clone with lenalidomide to achieve meaningful responses.[15]
A subsequent phase III study randomly assigned lower-risk del(5q) MDS patients to receive placebo and lenalidomide at either 5 mg daily for 28 days or 10 mg daily for 21 days of a 28-day cycle.[16] Transfusion independence responses lasting longer than 6 months occurred in 43% to 52% of subjects treated on the lenalidomide arms, compared with 6% of controls. The cytogenetic response rate was 25% to 50% on the active treatment arms, and the 3-year risk of AML transformation was 25%.
Lenalidomide has limited activity in lower-risk, red blood cell transfusion–dependent patients in MDS who do not harbor the del(5q) lesion. In a phase II study similar in design to the registration study, 56 of 215 patients (26%) achieved transfusion independence.[17] Median duration of response was 41 weeks (range, 8–136 weeks). Grade 3 or 4 myelosuppression occurred in only 20% to 25% of patients and, unlike for del(5q) patients, was not associated with subsequent attainment of a transfusion independence response to therapy.
Immunosuppressive therapy
Antithymocyte globulin (ATG) has shown activity in MDS patients in several small series. The National Heart, Lung, and Blood Institute conducted a phase II trial including 25 MDS patients with less than 20% blasts. Of all the patients studied, 11 (or 44%) responded and became transfusion-independent after ATG (three complete responses, six partial responses, and two minimal responses).[18] Multivariate analysis identified HLA-DR-15 (phenotype) expression, briefer period of red cell transfusion dependence, and younger age as predictors of response to ATG.[19] One study used alemtuzumab to treat a heavily preselected population of lower-risk MDS patients, in whom the response rate was 80%.[20]
DNA methyltransferase inhibitors
The nucleoside analogues azacitidine and decitabine are inhibitors of DNA methyltransferase. Both drugs require prolonged administration before benefits are seen. The median number of cycles required to see first hematologic response to azacitidine was 3; 90% of responders showed response by 6 cycles; and the median number of cycles of decitabine required to see first response was 2.2.[21] Azacitidine received FDA approval based on the results of a randomized trial that was not designed to study survival.[22]
A phase III randomized controlled trial (AZA PH GL 2003 CL 001 [NCT00071799]) of azacitidine versus other regimens, including low-dose cytarabine, AML-type remission induction chemotherapy, or best supportive care, was limited to patients with higher-risk MDS subtypes (IPSS intermediate-2 risk and high risk).[17] The median and 2-year overall survival (OS) favored the azacitidine arm, at 24 months versus 16 months (P = .0001) and 51% versus 26% (P < .0001), respectively.[17][Level of evidence A1] The FDA-approved azacitidine dose schedule used in this study (75 mg/m2 per day for 7 consecutive days) has proven inconvenient to some practitioners. A community-based study has suggested that alternate dosing schedules may provide similar hematologic benefits; however, the impact of such dosing schedules on survival is not known.[23]
While the azacitidine congener decitabine demonstrated similar activity in phase II trials, two randomized trials of decitabine versus supportive care failed to show a survival benefit.[21,24] Both decitabine studies used the FDA-approved dose schedule (15 mg/m2 every 8 hours for nine doses). In the European phase III study in higher-risk patients, median OS was similar for patients in both the decitabine and best supportive care arms, at 10.1 months versus 8.5 months, respectively (P = .38). A combined OS and delay in AML transformation end point was 8.8 months versus 6.1 months, respectively (P = .24).[25][Level of evidence A1]
Decitabine can be given as daily intravenous or subcutaneous infusions at doses that differ from the original labeled schedule, with hematologic response rates that appear comparable to the phase III study.[26,27]
Both of these drugs have been approved for refractory anemia, RARS (if accompanied by neutropenia or thrombocytopenia or requiring transfusions), refractory anemia with excess blasts, and refractory anemia with excess blasts in transformation. However, the highest response rates and levels of evidence have been generated in trials in which patients with higher-risk MDS (IPSS risk groups of intermediate-2 or high) were treated.[28] In lower-risk patients, response rates appear similar to those in higher-risk patients, although the survival benefit is unknown. The use of these drugs in low-risk patients may preclude their subsequent use upon disease progression.
Combinations of azacitidine with lenalidomide [29] and vorinostat [30] were compared with single-agent azacitidine in a national randomized phase II trial (S1117 [NCT01522976]).
AML induction-type chemotherapy
Induction chemotherapy typically used to treat AML may be used to treat patients with higher-risk MDS with excess blasts.[31] Low-dose cytarabine has benefitted some patients; however, this treatment was associated with a higher infection rate when compared with observation in a randomized trial. No difference in time to progression or OS was observed for patients treated with low-dose cytarabine or supportive care.
Allogeneic Hematopoietic Stem Cell Transplantation (HSCT)
Allogeneic HSCT is the only potentially curative treatment for MDS. Retrospective data suggest cure rates in selected patients ranging from 30% to 60%; outcomes varied with IPSS score at time of transplant, with inferior survival in patients with higher IPSS scores.[32][Level of evidence C3] The role of cytoreductive therapy in reducing the blast percentage before HSCT remains uncertain. Outcomes may not be as good for patients with treatment-related MDS (5-year disease-free survival rate of 8% to 30%).[33]
Although HSCT represents the only treatment modality with curative potential, the relatively high morbidity and mortality of this approach limits its use. A decision analysis predating approval of azacitidine, in patients with a median age younger than 50 years, suggested optimal survival when transplant was delayed until disease progression for lower-risk patients but implemented at diagnosis for higher-risk patients.[34]
Allogeneic stem cell transplantation with reduced-intensity conditioning (RIC) has extended transplantation as a possible modality for treatment of older patients.[35] In a retrospective analysis of 1,333 patients aged 50 years or older (median, 56 years) who underwent allogeneic transplants for MDS using HLA-matched sibling and unrelated donors, 62% of the patients received RIC HSCT, and the others received standard-dose HSCT. On multivariate analysis, use of RIC and advanced disease stage at transplantation were associated with increased relapse (hazard ratio [HR] of 1.44 and 1.51, respectively).[35][Level of evidence C3] The predictors of non-relapse mortality included advanced disease stage (HR, 1.43), use of an unrelated donor, and standard-dose HSCT (HR, 1.27). The 4-year OS rate was similar in both groups (30% after myeloablative conditioning vs. 32% in RIC.[35]
Therapy-Related Myeloid Neoplasms
In the absence of prospective data, therapy-related myeloid neoplasms are treated similarly to de novo MDS.
Current Clinical Trials
Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.
- Tricot GJ, Lauer RC, Appelbaum FR, et al.: Management of the myelodysplastic syndromes. Semin Oncol 14 (4): 444-53, 1987. [PUBMED Abstract]
- Boogaerts MA: Progress in the therapy of myelodysplastic syndromes. Blut 58 (6): 265-70, 1989. [PUBMED Abstract]
- Hellström-Lindberg E: Efficacy of erythropoietin in the myelodysplastic syndromes: a meta-analysis of 205 patients from 17 studies. Br J Haematol 89 (1): 67-71, 1995. [PUBMED Abstract]
- Park S, Grabar S, Kelaidi C, et al.: Predictive factors of response and survival in myelodysplastic syndrome treated with erythropoietin and G-CSF: the GFM experience. Blood 111 (2): 574-82, 2008. [PUBMED Abstract]
- Mannone L, Gardin C, Quarre MC, et al.: High-dose darbepoetin alpha in the treatment of anaemia of lower risk myelodysplastic syndrome results of a phase II study. Br J Haematol 133 (5): 513-9, 2006. [PUBMED Abstract]
- Gabrilove J, Paquette R, Lyons RM, et al.: Phase 2, single-arm trial to evaluate the effectiveness of darbepoetin alfa for correcting anaemia in patients with myelodysplastic syndromes. Br J Haematol 142 (3): 379-93, 2008. [PUBMED Abstract]
- Jädersten M, Montgomery SM, Dybedal I, et al.: Long-term outcome of treatment of anemia in MDS with erythropoietin and G-CSF. Blood 106 (3): 803-11, 2005. [PUBMED Abstract]
- Hellström-Lindberg E, Gulbrandsen N, Lindberg G, et al.: A validated decision model for treating the anaemia of myelodysplastic syndromes with erythropoietin + granulocyte colony-stimulating factor: significant effects on quality of life. Br J Haematol 120 (6): 1037-46, 2003. [PUBMED Abstract]
- Hellström-Lindberg E, Ahlgren T, Beguin Y, et al.: Treatment of anemia in myelodysplastic syndromes with granulocyte colony-stimulating factor plus erythropoietin: results from a randomized phase II study and long-term follow-up of 71 patients. Blood 92 (1): 68-75, 1998. [PUBMED Abstract]
- Hellström-Lindberg E, Kanter-Lewensohn L, Ost A: Morphological changes and apoptosis in bone marrow from patients with myelodysplastic syndromes treated with granulocyte-CSF and erythropoietin. Leuk Res 21 (5): 415-25, 1997. [PUBMED Abstract]
- Negrin RS, Stein R, Doherty K, et al.: Maintenance treatment of the anemia of myelodysplastic syndromes with recombinant human granulocyte colony-stimulating factor and erythropoietin: evidence for in vivo synergy. Blood 87 (10): 4076-81, 1996. [PUBMED Abstract]
- Greenberg PL, Rigsby CK, Stone RM, et al.: NCCN Task Force: Transfusion and iron overload in patients with myelodysplastic syndromes. J Natl Compr Canc Netw 7 (Suppl 9): S1-16, 2009. [PUBMED Abstract]
- List A, Dewald G, Bennett J, et al.: Lenalidomide in the myelodysplastic syndrome with chromosome 5q deletion. N Engl J Med 355 (14): 1456-65, 2006. [PUBMED Abstract]
- List A, Kurtin S, Roe DJ, et al.: Efficacy of lenalidomide in myelodysplastic syndromes. N Engl J Med 352 (6): 549-57, 2005. [PUBMED Abstract]
- Sekeres MA, Maciejewski JP, Giagounidis AA, et al.: Relationship of treatment-related cytopenias and response to lenalidomide in patients with lower-risk myelodysplastic syndromes. J Clin Oncol 26 (36): 5943-9, 2008. [PUBMED Abstract]
- Fenaux P, Giagounidis A, Selleslag D, et al.: RBC transfusion independence and safety profile of lenalidomide 5 or 10 mg in pts with low- or int-1-risk MDS with Del5q: results from a randomized phase III trial (MDS-004). [Abstract] Blood 114 (22): A-944, 2009.
- Fenaux P, Mufti GJ, Hellstrom-Lindberg E, et al.: Efficacy of azacitidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: a randomised, open-label, phase III study. Lancet Oncol 10 (3): 223-32, 2009. [PUBMED Abstract]
- Molldrem JJ, Caples M, Mavroudis D, et al.: Antithymocyte globulin for patients with myelodysplastic syndrome. Br J Haematol 99 (3): 699-705, 1997. [PUBMED Abstract]
- Saunthararajah Y, Nakamura R, Nam JM, et al.: HLA-DR15 (DR2) is overrepresented in myelodysplastic syndrome and aplastic anemia and predicts a response to immunosuppression in myelodysplastic syndrome. Blood 100 (5): 1570-4, 2002. [PUBMED Abstract]
- Sloand EM, Olnes MJ, Shenoy A, et al.: Alemtuzumab treatment of intermediate-1 myelodysplasia patients is associated with sustained improvement in blood counts and cytogenetic remissions. J Clin Oncol 28 (35): 5166-73, 2010. [PUBMED Abstract]
- Kantarjian H, Issa JP, Rosenfeld CS, et al.: Decitabine improves patient outcomes in myelodysplastic syndromes: results of a phase III randomized study. Cancer 106 (8): 1794-803, 2006. [PUBMED Abstract]
- Silverman LR, Demakos EP, Peterson BL, et al.: Randomized controlled trial of azacitidine in patients with the myelodysplastic syndrome: a study of the cancer and leukemia group B. J Clin Oncol 20 (10): 2429-40, 2002. [PUBMED Abstract]
- Lyons RM, Cosgriff TM, Modi SS, et al.: Hematologic response to three alternative dosing schedules of azacitidine in patients with myelodysplastic syndromes. J Clin Oncol 27 (11): 1850-6, 2009. [PUBMED Abstract]
- Wijermans P, Lübbert M, Verhoef G, et al.: Low-dose 5-aza-2'-deoxycytidine, a DNA hypomethylating agent, for the treatment of high-risk myelodysplastic syndrome: a multicenter phase II study in elderly patients. J Clin Oncol 18 (5): 956-62, 2000. [PUBMED Abstract]
- Lübbert M, Suciu S, Baila L, et al.: Low-dose decitabine versus best supportive care in elderly patients with intermediate- or high-risk myelodysplastic syndrome (MDS) ineligible for intensive chemotherapy: final results of the randomized phase III study of the European Organisation for Research and Treatment of Cancer Leukemia Group and the German MDS Study Group. J Clin Oncol 29 (15): 1987-96, 2011. [PUBMED Abstract]
- Issa JP, Garcia-Manero G, Giles FJ, et al.: Phase 1 study of low-dose prolonged exposure schedules of the hypomethylating agent 5-aza-2'-deoxycytidine (decitabine) in hematopoietic malignancies. Blood 103 (5): 1635-40, 2004. [PUBMED Abstract]
- Kantarjian H, Oki Y, Garcia-Manero G, et al.: Results of a randomized study of 3 schedules of low-dose decitabine in higher-risk myelodysplastic syndrome and chronic myelomonocytic leukemia. Blood 109 (1): 52-7, 2007. [PUBMED Abstract]
- Kaminskas E, Farrell A, Abraham S, et al.: Approval summary: azacitidine for treatment of myelodysplastic syndrome subtypes. Clin Cancer Res 11 (10): 3604-8, 2005. [PUBMED Abstract]
- Sekeres MA, List AF, Cuthbertson D, et al.: Phase I combination trial of lenalidomide and azacitidine in patients with higher-risk myelodysplastic syndromes. J Clin Oncol 28 (13): 2253-8, 2010. [PUBMED Abstract]
- Garcia-Manero G, Estey EH, Jabbour E, et al.: Final report of a phase II study of 5-azacitidine and vorinostat in patients with newly diagnosed myelodysplastic syndrome or acute myelogenous leukemia not eligible for clinical trials because poor performance and presence of other comorbidities. [Abstract] Blood 118 (21): A-608, 2011.
- de Witte T, Suciu S, Verhoef G, et al.: Intensive chemotherapy followed by allogeneic or autologous stem cell transplantation for patients with myelodysplastic syndromes (MDSs) and acute myeloid leukemia following MDS. Blood 98 (8): 2326-31, 2001. [PUBMED Abstract]
- Deeg HJ, Storer B, Slattery JT, et al.: Conditioning with targeted busulfan and cyclophosphamide for hemopoietic stem cell transplantation from related and unrelated donors in patients with myelodysplastic syndrome. Blood 100 (4): 1201-7, 2002. [PUBMED Abstract]
- Witherspoon RP, Deeg HJ, Storer B, et al.: Hematopoietic stem-cell transplantation for treatment-related leukemia or myelodysplasia. J Clin Oncol 19 (8): 2134-41, 2001. [PUBMED Abstract]
- Cutler CS, Lee SJ, Greenberg P, et al.: A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome. Blood 104 (2): 579-85, 2004. [PUBMED Abstract]
- Schetelig J, van Biezen A, Brand R, et al.: Allogeneic hematopoietic stem-cell transplantation for chronic lymphocytic leukemia with 17p deletion: a retrospective European Group for Blood and Marrow Transplantation analysis. J Clin Oncol 26 (31): 5094-100, 2008. [PUBMED Abstract]
Treatment of Relapsed or Refractory MDS
Lack of response or progression after the use of erythropoiesis-stimulating agents is not considered relapsed or refractory myelodysplastic syndromes (MDS).
With the exception of the use of lenalidomide for low-risk patients with abnormalities of chromosome 5, there are no clinical trials informing the appropriate selection of therapies for patients with specific subtypes of MDS. Patients who have ceased to respond or did not respond to one therapy are frequently offered another from the therapies described in the previous sections. Retrospective data suggest that patients who do not respond or have ceased responding to DNA methyltransferase inhibitors have a median survival of only 4 to 6 months.[1,2] Patients with relapses should be considered for enrollment in clinical trials.
Current Clinical Trials
Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.
- Prébet T, Gore SD, Esterni B, et al.: Outcome of high-risk myelodysplastic syndrome after azacitidine treatment failure. J Clin Oncol 29 (24): 3322-7, 2011. [PUBMED Abstract]
- Jabbour E, Garcia-Manero G, Batty N, et al.: Outcome of patients with myelodysplastic syndrome after failure of decitabine therapy. Cancer 116 (16): 3830-4, 2010. [PUBMED Abstract]
Current Clinical Trials
Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.
Latest Updates to This Summary (09/30/2022)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® Cancer Information for Health Professionals pages.
About This PDQ Summary
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of myelodysplastic syndromes. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
- be discussed at a meeting,
- be cited with text, or
- replace or update an existing article that is already cited.
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewer for Myelodysplastic Syndromes Treatment is:
- Aaron Gerds, MD (Cleveland Clinic Taussig Cancer Institute)
Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's Email Us. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
Permission to Use This Summary
PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary]."
The preferred citation for this PDQ summary is:
PDQ® Adult Treatment Editorial Board. PDQ Myelodysplastic Syndromes Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/myeloproliferative/hp/myelodysplastic-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389450]
Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.
Based on the strength of the available evidence, treatment options may be described as either "standard" or "under clinical evaluation." These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
Contact Us
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website's Email Us.


text:
Gracious Tribute Arrangement Pink
- ▼Details about these flowers
Send a beautiful expression of your love and concern at this difficult time with this beautiful basket in shades of white and pinks
- Arrangement will be similar in shape to image, however exact flowers will vary depending on seasonal availability and will not be exactly as image.
- Usually sent by family, friends or business associates
- Delivered directly to the funeral home or church
- Our florists use only the freshest flowers available, so colors and varieties will vary
- Large arrangement measures approximately 27"H x 24"L Upgraded versions will be more full and use more premium flowers such as roses, lily and orchids
- Your choice of with or without bow.
- ▼Delivery Details
Please have your orders in by the following times to ensure delivery on requested date:
12:00 Noon for same day residential, hospital and care facilities & pick-ups. Monday to Friday
-10:00am same day for business delivery before 4:00pm Mon-Fri
Saturday Deliveries must be in by 2pm Friday prior or Thursday if Friday is a holiday.
3:00pm for next day deliveries outside the perimeter. Mon-Fri.
All deliveries entered after cut off times will automatically be moved to next business day.
How soon will my gift be delivered?
We create each floral arrangement fresh for you, so please allow us a bit of time to put some care into creating your gift. All gift to offices are delivered by 4pm, gifts to homes by 6pm on the requested day. For timed and after hours deliveries please refer to full delivery details page linked below.
You will be notified by email when your gift has been delivered.
Will the recipient be contacted?
All recipients will be contacted prior to delivery unless business or care facility option is chosen during checkout with the exception of MOTHER'S DAY. We will not be calling in advance except for apartments or specifically requested.
- ▼Frequently asked questions
What happens if the person is not home?
For orders going to residential homes, we contact the person prior to sending out your gift and coordinating a time with them for delivery. You will be notified by email on delivery updates.
For deliveries to care facilities, business and hospitals, we do not call in advance. Please ensure the recipient will be there on the day you have requested a delivery.
Can I add a large card, chocolate or balloon to my order?
Yes, after you have added your item to the cart, the next step will allow you to choose from chocolates, balloons, stuffed toys ect.
Will my arrangement look exactly like the picture?
We always strive to create your floral gift as close as possible to the image, using the best flowers of the season. Some variations may occur, however the overall look will be equally lovely. Should the designer feel we cannot achieve a equally beautiful look with in season blooms, we will contact you via email to offer you options. You can see our full substitution policy here:
Please select all options.


text:
Published 12:00 am Friday, February 8, 2013
PEBBLE BEACH, Calif. — Hunter Mahan was bracing for the worst of Pebble Beach, his golf bag weighed down with rain gear and everything else to handle nasty weather.
Instead, he was reminded how much he loves this place.
It helps that Mahan drilled a 3-wood onto the 18th green for a two-putt birdie that gave him a 6-under 66 and a share of the lead to par with Russell Knox in the Pebble Beach National Pro-Am.
Better yet, the rain everyone was expecting early in the afternoon never showed up.
So when Mahan was asked about the most interesting part of the day, all he could think of was that it was boring — in a good way.
"I had a good time with my partner. The pace was great. The weather was good," he said. "I think the most interesting thing was we had perfect weather when it was supposed to rain at noon. We were all expecting rain. The bag probably weighs 100 pounds right now."
Mahan took advantage of a gorgeous day by attacking Pebble Beach, the place to be when the conditions are calm. He missed only two greens — one of those on the edge — and only had one birdie attempt longer than 20 feet.
It was a good start, but nothing more. With three very different courses in the rotation, weather than can change without notice and one course with a different par, no one has a good idea where they stand until after three rounds on Saturday.
Knox, who grew up in northern Scotland and has family roots in California, made the most of his limited starts on the PGA Tour. He had a 6-under 64 on the Shore Course at Monterey Peninsula. Knox finished out of the top 125 on the money list last year as a rookie, so his opportunities will be limited this year.
"I came in here with a lot of confidence because I feel like I've been playing very well," Knox said. "Just haven't had the chance to play. It was nice to get off to a good start."
The best round might have belonged to Seung-yul Noh of South Korea, who played at Spyglass Hill. It's typically the toughest of the three courses when conditions are benign, and such was the case on Thursday.
Pebble and Monterey Peninsula played nearly a half-shot under par, while Spyglass was almost a half-shot over par.
Noh reached 7 under until making bogeys on the last two holes for a 5-under 67, which only slightly soured his day. He still had the best score at Spyglass.
"Still a good score. I'm really happy with that," Noh said.
Even more impressive is that he felt half-asleep. Noh played in Dubai last week and is still coping with jet lag.
Also at 5 under were Scott Langley (65 at Monterey Peninsula) and Matt Every, who had a bogey on his final hole at Pebble Beach for a 67.
The day was not without a few adventures.
Former Secretary of State Condoleezza Rice, among the newest members at Augusta National, beaned a spectator on the sixth hole. Dustin Johnson, a two-time winner at the Pebble Beach National Pro-Am, had a four-putt on his way to a 3-over 73 at Monterey Peninsula. John Daly had a three-putt from 3 feet on the seventh hole and took four to get down from about 18 feet just off the ninth green. He had a 77.
Vijay Singh had a 72 at Pebble Beach, evidence that the PGA Tour still has not decided whether he will be suspended for using deer-antler spray, according to a Sports Illustrated and later confirmed by Singh's statement last week in Phoenix. The spray is said to contain an insulin-like growth hormone on the tour's list of banned substances.
A decision is not expected this week.
Phil Mickelson, going after a record-tying fifth win in this tournament, couldn't make as many putts at Monterey Peninsula as he did in his wire-to-wire win at Phoenix Open last week. He opened with a 69 at Monterey Peninsula.
"One of the things I've learned over the years here is you need to be patient," Mickelson said. "There's plenty of birdie holes throughout the three courses. Hopefully, I'll get a good run tomorrow and try to shoot myself up into contention."
Lee Westwood made his debut in this tournament by playing with his father, and while he had a 68, he's not sure the score had any bearing on having a good time. Westwood was at Pebble Beach, and while it was a good start for him, he made up ground in the wrong places.
The scoring at Pebble comes on the opening seven holes. He played those in 1 under, missed three putts inside about 12 feet. Then, he picked up four birdies over his final 10 holes.
"But it was nice doing it all with Dad and being able to walk the fairways," Westwood said. "You sort of tick off bucket-list courses, and Pebble Beach would definitely be one of them. To actually play in a competition in the AT&T with your dad and tick that one off something really special."
About the only thing Mahan he doesn't like about this tournament are his memories, particularly two years ago. He made a furious rally on the back nine, twice was tied for the lead, and then reached the par-5 18th in two in the final round. But he three-putted for par, giving D.A. Points a cushion. Mahan was runner-up by two shots.
"It was disappointing to finish second in 2011, so I definitely want to win here," he said. "This is an historic tournament, so I think anyone that tees it up here knows the importance of it and knows that to be a champion, what this would mean. I'm excited to be in this position right now, but obviously there's a lot of work to do. I do look forward to this every year, and definitely want to win this tournament at some point in my career."


text:
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