Myelodysplastic Syndromes Treatment
Once myelodysplastic syndrome has been detected and classified, your team of specialists in hematology, oncology, radiation oncology, and pathology will work together to assess the best course of treatment for your type of MDS. This may include chemotherapy, targeted drugs, or a stem cell transplant; there is no surgical treatment for MDS.
Myelodysplastic Syndromes: Watchful Waiting
For patients at low risk, with sufficient blood counts and not needing transfusions, watchful waiting is generally recommended. These patients may be able to maintain their normal activities, but their health and blood counts will be monitored closely.
Myelodysplastic Syndromes: Transfusions
Some MDS patients need ongoing blood transfusions to relieve MDS symptoms.
Patients who have symptoms of low red blood cell count like fatigue and shortness of breath receive red blood cell transfusions. They are monitored for “iron overload”, which can damage the heart and liver; there are medications that remove excess iron if necessary.
To alleviate symptoms like unusual bleeding or bruising, or to prepare for a procedure that may cause bleeding, platelet transfusions are provided.
Myelodysplastic Syndromes: Medications
Drugs used to increase the number of healthy blood cells your body produces include:
- Growth factors, artificial versions of substances found in bone marrow that increase red or white blood cell production.
- Erythropoietin (EPO), a protein produced in the kidneys that help red blood cells develop. In about a quarter of MDS patients, synthetic EPO injected under the skin several times a week raises the red blood cell count, avoiding the need for transfusions.
- Medications that stimulate blood cells to mature, rather than remain immature. These may improve quality of life and delay progression to acute leukemia. But these drugs aren't effective in all patients, and can cause further blood cell problems.
- Some patients, usually those considered low to intermediate risk, respond to the use of an immune globulin called antithymocyte globulin, derived from rabbits or horses and administered intravenously.
- For MDS associated with the genetic abnormality isolated del(5q), your WellStar physician may recommend lenalidomide (Revlimid), which can reduce the necessity for transfusions.
- Antibiotics fight infections that the body cannot.
Myelodysplastic Syndromes: Chemotherapy
MDS chemotherapy uses drugs to destroy abnormal blood cells or stop them from dividing.
Chemotherapy may be an option for high-risk patients who are in good overall health but do not have a suitable donor for a blood or marrow transplant (see below); it is also sometimes used to bring MDS into remission before a patient receives a transplant. However, the intense form of chemotherapy used for MDS (induction chemotherapy) may not be suitable for some older, less healthy patients.
About half of patients treated with induction chemotherapy reach a remission, but relapse is common and the rate of long-term survival is low, particularly in older patients.
Myelodysplastic Syndromes: Chemotherapy and Stem Cell Transplant
Blood stem cells are harvested from the blood or bone marrow of a compatible donor, and frozen. After your defective stem cells are destroyed with intense chemotherapy, they are replaced with the donated cells.
Unfortunately, the risk of transplant-related complications is high, especially in the older people whom MDS tends to strike. However, high-risk MDS patients who are under age 55 who undergo stem-cell transplantation enjoy a 40 to 50 percent long-term remission rate.