Retuning the immune system in myelodysplastic syndromes: from immunomodulatory approaches to vaccination strategies and non myeloablative hemopoietic cell transplant

Several findings suggest that the pathogenesis and clinical history of myelodysplastic syndromes (MDS) is influenced by a variety of immune pathways and mechanisms. Coherently several therapeutic approaches based on the idea of modulating the immune system have been exploited in this clinical setting. The present review will first consider more consolidated strategies such as antithymocyte globulin and immunomodulatory (IMiDs) analogues. Less explored approaches, such as anti tumor necrosis factor antibodies, cyclosporin and bortezomib will be also evaluated. Finally the potential impact of anti-tumour vaccination or hemopoietic cell transplantation on the outcome of MDS patients will be addressed.