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Myelodysplastic Syndromes

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by Cote S

(MDS; Myelodysplasia; Preleukemia; Smoldering Leukemia; Subacute Leukemia)

 

Symptoms

 

Treatment

Treatment for MDS depends on your age, other medical conditions, and how serious the disease is. Treatment also depends on how far along the disease has progressed to AML. Often, treatment includes relieving the symptoms of MDS. Talk with your doctor about the best treatment plan for you. You may be referred to a hematologist and an oncologist. A hematologist specializes in blood diseases. An oncologist specializes in cancer. Treatment options include:

Blood Transfusion

If you have a low red blood cell, white blood cell, or platelet count, you may receive a blood transfusion. A blood transfusion is a treatment that involves receiving blood products (red cells, white cells, platelets, clotting factors, plasma, or whole blood) through a vein. The blood components may come from an unrelated donor, from a related donor, or may have been banked in advance by the recipient.

Antibiotics

If you have a low white blood cell count, you may receive antibiotics to fight infection.

Growth Factors

Growth factors help the bone marrow produce blood cells. The following growth factors may be used to treat MDS:
  • Erythropoietin (EPO) is a growth factor that helps the bone marrow produce red blood cells.
  • Granulocyte colony-stimulating factors (G-CSF) and granulocyte macrophage colony-stimulating factors (GM-CSF) are growth factors that help the bone marrow produce white blood cells. Pegfilgrastim (Neulasta) is a form of G-CSF that is longer acting.
  • Oprelvekin (Neumega, interleukin-11, or IL-11) is a drug that helps the body produce platelets.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms including: pill, injection, or via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.
Standard Chemotherapy
There are three combinations of chemotherapy drugs used to treat MDS. These combinations include:
  • Cytarabine and idarubicin
  • Cytarabine and topotecan
  • Cytarabine and fludarabine
Hypomethylating Agents
Hypomethylating agents are drugs that slow down the growth of cells, and include:
  • Decitabine (Dacogen)
  • Azacitidine (Vidaza)
Immunomodulating Therapy
Immunomodulating drugs change the immune system, and include:
  • Thalidomide
  • Lenalidomide (Revlimid)
Immunosuppression Agents
Immunosupression agents suppress the immune system, and include:
  • Anti-thymocyte globulin (ATG)
  • Cyclosporine

Stem Cell Transplant

The only cure for MDS is a stem cell transplant (SCT) . A SCT starts with high-dose chemotherapy to kill the bone marrow, and is then followed by an injection of healthy stem cells. The stem cells used can come from the blood or bone marrow.
There are two types of SCT. The less common one is called an autologous SCT, and occurs when the patient is injected with her own cells after high-dose chemotherapy. The more common method is called allogeneic and occurs when a patient gets donor cells after high-dose chemotherapy.
Many doctors will only perform an SCT on a patient that is aged 50 or younger.
 

RESOURCES

American Cancer Society
http://www.cancer.org

Leukemia and Lymphoma Society
http://www.leukemia-lymphoma.org

Myelodysplastic Syndromes Foundation
http://www.mds-foundation.org

 

CANADIAN RESOURCES

Aplastic Anemia and Myelodysplasia Association of Canada
http://www.aamac.ca

Neutropenia Support Association
http://www.neutropenia.ca

 

References


Ableoff M, ed. Clinical Oncology. 4th ed. Philadelphia, PA: Elsevier; 2005.


Ableoff M, ed. Clinical Oncology. 3rd ed. Philadelphia, PA: Elsevier; 2004.


Cancer Prevention page. American Cancer Society website. Available at: http://www.cancer.org/docroot/PED/ped%5F1.asp?sitearea=PED . Accessed September 28, 2005.


Detailed guide: myelodysplastic syndrome. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/CRI%5F2%5F3x.asp?dt=65 . Accessed April 2, 2009.


Frequently asked questions about MDS page. The Myelodysplastic Syndromes Foundation website. Available at: http://www.mds-foundation.org/pdf/CEL411%20Factsht%20v8.pdf . Accessed September 14, 2005.


Goldman L, ed. Cecil Textbook of Medicine. 22nd ed. Philadelphia, PA: W.B. Saunders Company; 2004.


Hoffman R, Benz E, Shattil S, et al, eds. Hematology: Basic Principles and Practice. 4th ed. Philadelphia, PA: Elsevier; 2005.


Myelodysplastic syndrome. Dynamed website. Available at: http://www.dynamicmedical.com/dynamed.nsf?opendatabase . Accessed September 13, 2005.


Myelodysplastic syndromes: a review for patients, families, friends, and healthcare professionals. Patient information page. The Myelodysplastic Syndromes Foundation website. Available at: http://www.mds-foundation.org/patientinfo.htm . Accessed September 14, 2005.


Myelodysplastic syndromes facts & statistics page. Leukemia and Lymphoma Society website. Available at: http://www.leukemia-lymphoma.org/all%5Fpage?item%5Fid=55445 . Accessed September 22, 2005.


Myelodysplastic syndromes page. National Marrow Donor Program website. Available at: http://www.marrow.org/PATIENT/myelodysplastic%5Fsyndromes.html . Accessed September 22, 2005.


Myelodysplastic syndromes: treatment page. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/myelodysplastic . Accessed: September 22, 2005.


Overview: myelodysplastic syndrome page. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/content/CRI%5F2%5F2%5F1x%5FWhat%5FAre%5FMyelodysplastic%5FSyndromes%5F65.asp?rnav=cri . Accessed September 22, 2005.


Understanding myelodysplastic syndromes: a patient handbook. Patient information page. The Myelodysplastic Syndromes Foundation website. Available at: http://www.mds-foundation.org/patientinfo.htm . Accessed September 14, 2005.

 

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