Myelodysplastic syndromes are a group of heterogeneous clonal disorders originating from hematopoietic myeloid-directed stem cells or pluripotent stem cells, characterized by ineffective hematopoiesis and a high risk of evolution to acute myeloid leukemia, with clinical manifestations of varying degrees of qualitative and quantitative abnormalities in hematopoietic cells. The incidence of MDS is about 10/100,000-12/100,000 population, mostly involving middle-aged and elderly people, with 50%-70% of cases over 50 years of age and a male to female ratio of 2:1. 30%-60% of MDS is converted into leukemia. In addition to leukemia, most of the deaths are due to infections and bleeding, especially intracranial hemorrhage. Clinical manifestations Symptoms: MDS usually starts slowly, with a few cases starting sharply. The transformation to leukemia usually starts from the onset of the disease, which is about 50% or more within a year. Anemia accounts for 90% of patients. It is often moderate anemia, manifested as pallor, dizziness and weakness, palpitations and shortness of breath after activity. Fever accounts for 50% of the cases, with fever of unknown origin accounting for 10%-15% of the cases, with the respiratory tract, perianal and urinary tract being the most common sites of infection. Hemorrhage accounts for 20%, commonly in the respiratory tract, gastrointestinal tract, but also by intracranial hemorrhage, early bleeding symptoms are mild, mostly skin and mucous membrane bleeding, gum bleeding or epistaxis, female patients may have excessive menstruation. In the late stage, the tendency of bleeding increases, and cerebral hemorrhage becomes one of the main causes of death in patients. Signs: Generally there are no special signs, only a few cases have enlarged liver, spleen and lymph nodes, and the enlarged spleen is often moderate or mild. In the late stage, there may be sternal pressure pain. Common complications Infection: acute leukemia The incidence of RA,RAS type evolving into acute myeloid leukemia in MDS is about 13%, with a survival of 50 months in this group; in the RAEB and CMML groups in MDS, 35%-40% evolve into acute myeloid leukemia, with a median survival of only 14-16 months. The median survival was only 14-16 months, while RAEB-T evolved into acute leukemia with a median survival of three months. Hemorrhage: About 20% of patients with MDS show signs of bleeding, commonly from the skin, respiratory tract, gastrointestinal tract, etc., but also from intracranial bleeding. Clinical treatment 1. Supportive therapy Regular transfusion of concentrated red blood cells in severe anemia to maintain a better quality of life. Those with platelets <20×109-30×109/L and obvious bleeding tendency can be transfused with concentrated platelets. Anti-infective therapy is indicated for those with co-infection, supplemented with intravenous gammaglobulin infusion if necessary. Those with iron overload due to repeated transfusions may be treated with iron expulsion, etc. Supportive therapy should be the basic treatment for low-risk MDS. Immunosuppressive therapy Since there is evidence that some MDS patients have abnormal immune function, some authors have tried immunosuppressive therapy for MDS in recent years and achieved certain efficacy. 3.Small dose single agent chemotherapy 4.Strong combination chemotherapy 5.Hematopoietic stem cell transplantation