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In addition, thrombocytopenia in <jats:styled-content style=\"fixed-case\">MDS<\/jats:styled-content> limits the tolerability and therapeutic efficacy of disease\u2010modifying therapies, such as azacitidine or lenalidomide. The recombinant human erythropoietin (r<jats:styled-content style=\"fixed-case\">H<\/jats:styled-content>u<jats:styled-content style=\"fixed-case\">EPO<\/jats:styled-content>) erythropoiesis\u2010stimulating agents, epoetin and darbepoetin, are an established component of anaemia management in lower\u2010risk <jats:styled-content style=\"fixed-case\">MDS<\/jats:styled-content>. Their success has, in turn, driven the development of haematopoietic growth factors targeting thrombocytopenia. While recombinant thrombopoietin (<jats:styled-content style=\"fixed-case\">THPO<\/jats:styled-content>) proved too immunogenic for clinical use, novel thrombopoiesis\u2010stimulating agents (<jats:styled-content style=\"fixed-case\">TSA<\/jats:styled-content>s) have the potential to reduce bleeding events, decrease dependency on platelet transfusions and extend exposure to disease\u2010modifying therapies. Two <jats:styled-content style=\"fixed-case\">TSA<\/jats:styled-content>s, eltrombopag and romiplostim, have demonstrated benefit in chronic immune thrombocytopenia purpura (<jats:styled-content style=\"fixed-case\">ITP<\/jats:styled-content>) and safety and efficacy data for use of these agents in <jats:styled-content style=\"fixed-case\">MDS<\/jats:styled-content> is growing. However, important safety concerns remain, such as the potential for stimulation of neoplastic myeloid clones by <jats:styled-content style=\"fixed-case\">THPO<\/jats:styled-content> agonists. In this narrative review, we discuss the rationale and biological mechanism for <jats:styled-content style=\"fixed-case\">TSA<\/jats:styled-content>s in <jats:styled-content style=\"fixed-case\">MDS<\/jats:styled-content>, describe the agents currently available and their mechanism of action, and present current clinical data relating to <jats:styled-content style=\"fixed-case\">TSA<\/jats:styled-content> safety and efficacy in the context of <jats:styled-content style=\"fixed-case\">MDS<\/jats:styled-content>.<\/jats:p>","DOI":"10.1111\/bjh.13285","type":"journal-article","created":{"date-parts":[[2015,2,6]],"date-time":"2015-02-06T23:29:14Z","timestamp":1423265354000},"page":"309-323","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Thrombopoiesis\u2010stimulating agents and myelodysplastic syndromes"],"prefix":"10.1111","volume":"169","author":[{"given":"Charlotte K.","family":"Brierley","sequence":"first","affiliation":[{"name":"Department of Haematology Oxford University Hospitals NHS Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David P.","family":"Steensma","sequence":"additional","affiliation":[{"name":"Division of Hematologic Malignancies Dana\u2010Farber Cancer Institute Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,2,6]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0145-2126(98)00132-5"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-002-0530-z"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0092-8674(94)90450-2"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/56.1.24"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2011.03382.x"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V88.8.2859.bloodjournal8882859"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2003.11.016"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2402129"},{"key":"e_1_2_13_10_1","first-page":"783","article-title":"Prognostic value of c\u2010mpl expression in myelodysplastic syndromes","volume":"9","author":"Bouscary D.","year":"1995","journal-title":"Leukemia"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.3109\/10428199509051699"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2006.06246.x"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cyto.2003.05.001"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa073275"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60402-5"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-07-514398"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60959-2"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2005-10-4149"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2005-06-2552"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.276.5319.1696"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2012-11-465575"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V85.2.391.391"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12253-010-9276-4"},{"key":"e_1_2_13_24_1","unstructured":"Desmond R.T. 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