MDS - What It Is, Symptoms and How It's Treated

by Jane Ashley

There is some confusion over what myelodysplastic syndromes (MDS) are – MDS used to be considered “pre-leukemia” or “smoldering leukemia.” In about one in three patients, MDS develops into acute myeloid leukemia (AML), a serious, fast-growing type of leukemia. Scientists and physicians once considered MDS as a blood disorder with a low potential for developing into cancer, but research now shows that it is a form of blood cancer.

35 People Daily Dignosed With Mds

What Is A Myelodysplastic Syndrome?

The National Cancer Institute defines myelodysplastic syndrome as:
A type of cancer in which the bone marrow does not make enough healthy blood cells (white blood cells, red blood cells, and platelets) and there are abnormal cells in the blood and/or bone marrow. When there are fewer healthy blood cells, infection, anemia, or bleeding may occur.
In other words, MDS lowers the levels of all three of our blood cells.

Red cells. Our red cells absorb oxygen in our lungs and deliver the oxygen to every cell in our body and then brings the carbon dioxide back to our lungs. A low red blood cell count is called anemia. Anemia causes a patient to be tired, weak and pale. If the anemia is severe, a patient might be short of breath.

White cells. Our white cells fight off infections from bacteria and viruses. We have three types of white cells: 1) Granulocytes, 2) Monocytes and 3) Lymphocytes. In MDS, patients may experience low granulocytes and monocyte counts and have abnormal lymphocytes.

Platelets. Our platelets are pieces of a large cell called a megakaryocyte — pieces of these large cells break off into the bloodstream to help clot our blood to prevent dangerous bleeding. Low platelet counts cause bruising and excessive bleeding from even a small cut.

Low blood counts may be picked up during an annual physical before a patient has any symptoms.

Statistics, Symptoms and Diagnosis of MDS

About 10,000 people in the U.S. are diagnosed every year with MDS. It is uncommon in people under 50 and most common in people over 70. Because the baby boomers are entering the over-65 population, experts expect MDS to increase.

Symptoms are subtle. Be certain to tell your doctor about these symptoms. Simple blood tests can rule out other causes of these symptoms.
Bone pain
Bruising and bleeding.
Fatigue
Fever
Frequent infections
Pale
Pinpoint-sized red spots on your skin
Shortness of breath
Weakness

75percent Of Mds Patients

In addition to a CBC (complete blood count), several other tests determine if a patient has MDS.

Peripheral (circulating) blood smears. A pathologist examines a thin layer of the patient’s blood to determine the percentage of the different types of blood cells and if any look abnormal compared to normal cells.

Bone marrow biopsy. This is the definitive diagnostic test. A pathologist examines the appearance of our bone marrow, determines the different cells counts and performs a chromosomal analysis.

Molecular testing. Laboratory tests determine if the patient has specific genes, proteins, and other factors that are specific to MDS. This information helps determine effective treatments.

Cytogenetic (chromosomal) analysis. About half of MDS patients have at least 1 chromosome abnormality. Patients with one chromosomal change are considered Primary MDS. Patients who have multiple chromosomal changes are termed Secondary MDS.

Immunophenotyping. This test detects antigens (a specific type of protein found on the cell surface) helping to guide treatment options.

Treatments for MDS

Patients are classified into sub-types based on these features.
Blood cell counts
Percent of blasts in the bone marrow
Risk of developing acute myeloid leukemia (AML)

Medicine treatments include chemotherapy, conventional therapy or immunotherapy. A patient’s treatment is determined, in part, by their International Prognostic Scoring System (IPSS-R) score. This score helps predict the chance of developing AML and overall survival. There are five scores, ranging from very low risk to very high risk.

About 30 to 40 percent of MDS patients benefit from chemotherapy.

Patients at high risk for developing AML benefit from conventional therapy drugs including Cytarabine, Daunorubicin or Idarubicin.
Lenalidomide (Revlimid) is very effective for low-risk patients and patients with the 5q chromosomal change.

The only current treatment that can produce a long-term remission is high-dose chemotherapy followed by either a bone marrow transplant or a stem cell transplant.

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WhatNext …

The MDS Foundation designates MDS Centers of Excellence. These centers have demonstrated skill in the treatment of MDS. Patients may want to consider obtaining a second opinion from one of these centers. New clinical trials offer hope for many patients.
MDS is often referred to as a bone marrow failure disorder which is considered a blood cancer.

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