Myelodysplastic syndromes

What is it?

Myelodysplastic syndromes (MDS) are a group of blood cancers. Normally, stem cells in the bone marrow grow into healthy red cells, white cells and platelets. In MDS many of them do not mature and die in the marrow. This leaves too few healthy blood cells, which can lead to anaemia (too few red cells), infections and bleeding.

MDS is rare and mostly affects older people: half are about 70 or older when they find out. In most people the cause is not known. The risk is higher after chemotherapy or radiotherapy for another cancer, and after contact with tobacco smoke, some chemicals (such as benzene, pesticides or fertilisers) or heavy metals such as lead and mercury.

The first signs

MDS often causes no early signs and is sometimes found by a routine blood test.

• feeling weak or tired;
• shortness of breath;
• skin that is paler than usual;
• bruising or bleeding easily, or tiny spots under the skin caused by bleeding;
• fever or infections that keep coming back.

How doctors find out

Blood tests count the red blood cells, white blood cells and platelets. A bone marrow test takes a small sample of marrow with a needle, and a lab checks it for abnormal cells and chromosome changes. Some of these tests, such as checking the chromosomes, help plan treatment.

Current treatment

Treatment depends on several factors. It can include transfusions, medicines that help make red blood cells, and antibiotics for symptoms; lenalidomide or azacitidine and decitabine for some people; and chemotherapy with a donor stem cell transplant for certain patients.

Will it get worse?

Prognosis (chance of recovery) and treatment options depend on certain factors. How it goes depends on how many immature cells (blasts) are in the marrow, how many kinds of blood cells are low, certain chromosome changes, whether it followed earlier cancer treatment, and your age and general health. Some types of MDS can turn into acute myeloid leukaemia (AML).

Medicines: what helps, and what to watch for

Supportive care eases the problems caused by the disease. It can include red blood cell or platelet transfusions, medicines that help the body make more red blood cells, and antibiotics to fight infection. Azacitidine or decitabine can slow the change to AML. Lenalidomide helps some people with a certain chromosome change (del(5q)) need fewer transfusions. People at high risk of AML may get the same chemotherapy as for AML.

Good to know:

• Many transfusions can build up too much iron in the body and harm organs; medicines can remove the extra iron;
• You can join a clinical trial before, during or after treatment, and some trials take only people who have not started treatment.

A transplant, for some people

Some people can be cured with strong chemotherapy followed by a stem cell transplant from a donor, which gives them healthy blood-forming cells. It may not work as well when MDS was caused by earlier cancer treatment.

Is there a cure?

For some people, yes: strong chemotherapy with a donor stem cell transplant can cure certain patients. There is no standard treatment when MDS comes back or stops responding. Clinical trials are testing new treatments.

See the 397 trials you can join

Median survival

About 2 years with azacitidine, in higher-risk MDS

Measured in: Higher-risk myelodysplastic syndromes: a phase III trial of azacitidine against conventional care (358 patients)

Sources

Written in plain words by Frontlight from these pages:

1. NCI PDQ: Myelodysplastic Syndromes Treatment (PDQ®) – Patient Version
2. MedlinePlus: Myelodysplastic Syndromes
3. NCI PDQ: Myelodysplastic Syndromes Treatment (PDQ®) – Health Professional Version
4. The Lancet Oncology: Efficacy of azacitidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: a randomised, open-label, phase III study