9. Chemotherapy

Systemic chemotherapy is the primary choice of treatment for both isolated MS and MS with simultaneous bone marrow involvement. This is largely due to the fact that even if there is no primary bone marrow involvement, isolated or primary MS ultimately gives rise to AML in majority of the cases [3, 39]. Consequently, the chemotherapy regimens for MS generally follow the same protocol as AML. All these regimens mainly include cytarabine with fludarabine, idarubicin, or both. In some instances, granulocyte colony-stimulating factor (G-CSF), daunorubicin and cyclophosphamide are also used [32, 37, 40]. In particular, combination therapy with cytarabine and daunorubicin has been demonstrated to achieve complete remission in 65% of MS patients. In addition, chemotherapy has also shown to be effective in attenuating AML development in isolated MS cases (71%) in both adult and pediatric population [37, 41]. However, at present there is not enough data to identify a specific chemotherapy plan that is beneficial for MS.
