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Myelodysplastic syndromes in the elderly.

MDS originates in the pluripotent stem cell. It involves all myeloid cell lines and may also involve lymphoid cell lines. Alteration of these cell lines leads to ineffective hematopoiesis and peripheral cytopenias. Apoptosis plays a role in the ineffective hematopoiesis. MDS is a highly proliferative disorder with an equally high degree of apoptosis and intramedullary cell death.2 Using an in situ end-labeling technique and the bone marrow of 21 patients with MDS, more than 70% of the cells were found to be undergoing cell death.3