About MDS (Myelodysplastic Syndrome)

Myelodisplastic Syndrome involves a group of disorders that are often called preleukemia. It is not generally known what puts someone at higher risk for MDS. Exposure to benzene, radiation and chemotherapy drugs are sometimes associated with MDS.
The most common symptom is anemia, an abnormally low number of white blood cells (neutropenia), and thrombocytopenia or a combination.  Patients with MDS often develop severe anemia and need frequent blood transfusions. In most cases, the disease worsens and the patient develops low blood counts (cytopenias) due to progressive bone marrow failure. In about one third of patients with MDS, the disease transforms into acute myelogenous leukemia (AML), usually within months to a few years.
The myelodysplastic syndromes are all disorders of the stem cell in the bone marrow. In MDS, blood production (hematopoiesis) is disorderly and ineffective. The number and quality of blood-forming cells decline irreversibly, further impairing blood production
Each year between 15,000 and 20,000 new cases of MDS are diagnosed in the US. Patients tend to be around the age of 70 at the time of diagnosis, although people of any age can develop the disease. MDS is classified as either primary (also called de novo) — disease that has no known cause — or secondary (also called treatment-related) MDS. Treatment-related MDS is caused by previous treatment with chemotherapy or radiation therapy, which is given for a previously diagnosed cancer. The number of new cases of MDS is rising, both because people are getting older and are now living longer after treatment for their first cancer.

Symptoms

• pallor
• weakeness
• fatigue
• fever and infections (neutropenia)
• increased bruising
• petechiae
• bloody nose (epistaxis)
• nosebleeds and bleeding gums caused by low platelet counts (thrombocytopenia)
• splenomegaly (enlargement of the spleen)
• hepatomegaly (enlargement of the liver)

Diagnosis
In order to diagnose MDS your doctor will ask you questions about your past health and symptoms. Your doctor will do a physical exam. MDS is suspected in elderly patients with refractory anemia, leukopenia or thrombocytopenia. Testing such as a complete blood count and bone marrow examination are completed.

Treatment
The treatment will try to eliminate or help the symptoms. Azacitidine is a medicine that relieves symptoms, decreases the rate of transformation to leukemia and the need for transfusions, and it probably also improves survival. About 16% of patients had a complete or partial response. Other therapy can include red blood cell (RBC) transfusions, platelet transfusions for bleeding, and antibiotics for bacterial infections. Another similar drug Deoxyazacitidine   is sometimes effective. About 20-40% of patients had a partial response to the medicine. Some patients require erythropoietin, a medicine, to support their red blood cell production. When there is a severe decrease in white cells Granulocyte colony stimulating factor (GSF) can be used, which is a growth factor produced by a number of different tissues to stimulate the bone marrow to produce granulocytes and stem cells.Thrombopoietin, a medicine that regulates production of platelets by the bone marrow can be used for severe thrombocytopenia. Allogeneic stem cells transplants are useful.

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