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Myelodysplastic Syndromes
(MDS)(Myelodysplasia, Preleukemia, Smoldering Leukemia, Subacute Leukemia)

Definition:
Myelodysplastic syndromes (MDS) are a group of diseases that involve dysfunction of the bone marrow. Bone marrow is the tissue found within the bones; its task is to create mature blood cells from stem cells. In all forms of MDS, this normal cell-creation process is disrupted by the overproduction of clones of a single stem cell. This leads to a decrease in production of normal red blood cells, white blood cells, and platelets.

There are five types of MDS. Some forms of MDS are more serious than others. All of them are serious enough to require a physician’s care. Thirty percent of people with MDS develop acute myeloid leukemia (AML). Leukemia is a cancer of the white blood cells and their parent cells. Many blood disease experts consider MDS to be a type of cancer.

Causes:
The cause of MDS is unknown, but research shows that certain risk factors are associated with the disease.

Risk Factors:
The following factors are associated with a higher risk for developing MDS:
  • Family members with MDS or Fanconi anemia (Fanconi anemia is a rare type of anemia)
  • Age: 60 or older
  • Sex: Men
  • Exposure to large amounts of radiation
  • Exposure to certain chemicals, such as benzene
  • Exposure to pesticides
  • Radiation therapy and/or chemotherapy treatment for cancer
  • Smoking
Symptoms:
  • Typically, there are no symptoms in the early stages of MDS. Later stage symptoms may vary from person to person, depending on how serious the disease is. Later stage symptoms may include:
  • Signs of anemia due to underproduction or red blood cells. Signs of anemia include:
    • Fatigue
    • Shortness of breath
    • Pale skin
    • Feeling weak and tired
    • Congestive heart failure (in severe cases)
  • Signs of neutropenia (inadequate levels of white blood cells). White blood cells fight infection in the body. Signs of neutropenia include:
    • Fever
    • Cough
    • Frequent, unusual, or especially serious infections
  • Signs of thrombocytopenia (inadequate levels of platelets in the blood.) Platelets stop bleeding by clotting the blood. Signs of thrombocytopenia include:
    • Bleeding easily, especially from the nose and gums
    • Bruising easily
Diagnosis:
Your doctor will ask about your symptoms and medical history, and perform a physical exam. The symptoms for MDS can indicate many other conditions. Doctors have to rule out other conditions before diagnosing someone with MDS.

Tests may include the following:

  • Blood test to check your red and white blood cell counts and platelet counts and to check how the blood cells look.
  • Bone marrow biopsy to check for MDS. A bone marrow biopsy is the removal of a sample of bone marrow for testing.
  • Your doctor may also order other tests to rule out other conditions.
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

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.

Stem cell transplant
Many doctors will only perform a stem cell transplant on a patient that is age 50 or younger. A stem cell transplant is a procedure in which healthy stem cells from a donor’s blood are injected into a recipient's vein.

Bone marrow transplant
Many doctors will only perform a bone marrow transplant on a patient that is age 50 or younger. A bone marrow transplant is a procedure in which healthy stem cells from a donor's bone marrow are injected into a recipient's vein.

Prevention:
To help reduce your chances of getting MDS, take the following steps:
  • Avoid exposure to hazardous chemicals such as benzene
  • Don’t smoke or if you do smoke, quit
  • Reduce your risk for developing cancer:
    • Eat a balanced, healthful diet
    • Stay active
    • Maintain a healthy weight
    • Avoid environmental and occupational risks
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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