What are the risk factors for MDS?

• Age – 60 years or older
• Heredity – having a family member with certain forms of MDS
• Past treatment with chemotherapy or radiation therapy
• Exposure to certain chemicals, including tobacco smoke, pesticides, and other solvents such as benzene.

What are the signs/symptoms of MDS?

The symptoms of MDS vary depending on the individual and the extent of the disease. Many patients have no symptoms when they are initially diagnosed because routine blood tests can? detect MDS. Symptoms may include the following:

• Shortness of breath
• Fatigue
• Skin that is paler than usual
• Easy bruising or bleeding
• Frequent infections
• Fever
• Weight loss

These symptoms could be the result of a number of illnesses. Always consult your physician for a proper diagnosis.

How is MDS diagnosed?

In addition to a physical exam and complete medical history, the following diagnostic tests may be used:

• Complete Blood Count (CBC)—a simple blood test which gives a profile of the components of your blood (red blood cells, white blood cells, platelets, and hemoglobin.)
• Peripheral Blood Smear—a sample of blood is checked for changes in the number, type, shape, and size of blood cells as well as for the amount of iron in the red blood cells.
• Bone Marrow Aspiration and/or Biopsy—a needle is inserted into the hipbone or breastbone to remove of a small piece of bone and/or bone marrow for analysis.
• Cytogenetic Analysis—a sample of blood or bone marrow cells are examined for certain changes in the chromosomes.

What are the different types of MDS?

There are several different types of MDS:

• Refractory anemia—This type of MDS affects only the red blood cells. Too few red blood cells cause the patient to become anemic. The number of white blood cells and platelets is normal.
• Refractory anemia with ringed sideroblasts—Similar to refractory anemia, this type of MDS is characterized by too few red blood cells. In addition, the red blood cells have too much iron. The number of white blood cells and platelets is normal.
• Refractory anemia with excess blasts—Again, there are too few red blood cells in the blood causing anemia. In addition, five percent to 19% of the cells in the bone marrow are blasts (immature blood cells) and there are an abnormal number of blasts found in the blood. Changes to the white blood cells and platelets are also possible. This type of MDS may progress to acute myeloid leukemia if 20 % or more of the cells in the bone marrow are blasts.
• Refractory cytopenia with multilineage dysplasia—In this type of MDS there are too few of at least two types of blood cells. Also, less than five percent of the cells in the bone marrow are blasts (immature blood cells) and less than one percent of the cells in the blood are blasts. There may be an excess of iron in the red blood cells as well. This type of MDS may progress to acute leukemia.
• Myelodysplastic syndrome associated with an islolated del(5q) chromosome abnormality—This type of MDS is caused by a chromosomal deficiency. Also, too few red blood cells cause anemia and less than five percent of the cells in the bone marrow and blood are blasts (immature blood cells.) Once associated with a dire prognosis, this type of MDS is now treatable with a new medication called lenalidomide.
• Unclassified myelodysplastic syndrome—This type of MDS is characterized by too few of just one type of blood cell in the blood. Also, the number of blasts (immature blood cells) in the bone marrow and blood is normal, and the disease is not one of the other forms of MDS.

What are the treatment options for patients with MDS?

• Supportive Care—Maintaining overall health and responding quickly to infections are extremely important for patients with MDS. Adequate amounts of certain vitamins and minerals, such as vitamin B12 and folic acid, are necessary to maximize the bone marrow’s ability to produce red blood cells. Transfusions of red blood cells or platelets are sometimes needed to maintain adequate blood counts. Iron levels are carefully monitored, especially in MDS patients receiving regular red blood cell transfusions, to avoid a potentially damaging overload of iron in the body. New medications which are effective in treating this iron overload are now available.
• Growth Factors—Growth factors are natural chemicals in the body that cause the bone marrow to produce blood cells. Recently, some growth factors have been manufactured as drugs for patients with MDS. These drugs are injected to stimulate the bone marrow to increase its blood cell production. By increasing blood counts these drugs can often reduce the need for blood transfusions.
• Immunosuppressive Drug Therapy—With some forms of MDS, the immune system may interfere with the bone marrow’s ability to produce normal blood cells. Immunosuppressive therapy (drugs that suppress the immune system) has been successful in treating patients with some forms of MDS.
• Chemotherapy—Currently, there are several drugs available for the treatment of MDS. Both FDA-approved and experimental (part of a clinical trial), these drugs affect bone marrow cell growth and maturation. (more info)
• Bone Marrow Transplants—At this time, the only option for curing MDS is a bone marrow transplant. In this procedure, bone marrow is taken from a healthy donor and given to the patient to replace the abnormal marrow. Bone marrow transplants are most successful in otherwise-healthy patients with marrow from a matched donor, most commonly, from a sibling.
• Lenalidomide –This is a new medication which is effective in treating MDS associated with an isolated del(5q) chromosome abnormality. It is just one example of a recent advancement turning a dire prognosis into a hopeful cure.

Huntington Hospital’s Don Monti Cancer Center participates in clinical trials for new drugs to treat patients with MDS. Click here for more information about clinical trials.

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