MDS: What Goes Into Treatment Decisions?
- Treatment for myelodysplastic syndrome (MDS) varies since there are many different forms of this disease.
- When doctors are determining how to treat a patient, they will initially look at what type of blood cells are affected, how the complete blood count (CBC) looks, how genetics are involved, and the patient’s overall health.
- Some patients with MDS may only need to have their blood counts regularly monitored and may not need treatment initially.
- For more severe cases, treatment approaches may include blood transfusions, chemotherapy or targeted therapy, bone marrow transplant, or a combination of approaches.
“The primary question that I asked myself when I see a patient with newly diagnosed MDS is, I look at their blood counts and I say, are any components of their blood counts — either their white blood cells, red blood cells, or platelets — is any component of their complete blood count (CBC) low enough that they require treatment?” Dr. Eytan Stein, chief of the Leukemia Service at Memorial Sloan Kettering Cancer Center, tells SurvivorNet.Read More
Determining the Type of MDSThere are several different types of MDS and patients are categorized based on which blood cells are affected.
Dr. Stein said doctors will consider which types of blood cells are low, how many types are low, and the genetic makeup of the person’s MDS. Determining the type of MDS a person has can help doctors figure out the best course of treatment.
The different types of MDS include:
- Refractory anemia (there are too few red blood cells)
- Refractory anemia with ring sideroblasts (there are too few red blood cells and those cells have too much iron)
- Refractory anemia with excess blasts (there are too few red blood cells and 5-19% of the cells in the bone marrow are blasts, which means immature red blood cells)
- Refractory cytopenia with multilineage dysplasia (there are too few of at least two types of blood cells and less than 5% blasts in the bone marrow and less than 1% blasts in the blood)
- Refractory cytopenia with unilineage dysplasia (there are too few of one type of blood cell and there have been changes in 10% or more in the other two types)
- Unclassifiable MDS (the number of blasts in the bone marrow are normal and the disease cannot be classified as any of the MDS types)
- MDS with a isolated del(5q) chromosome abnormality (there are too few red blood cells, less than 5% of cells in the bone marrow are blasts and less than 1% in the blood are blasts, and there is a specific change in the 5q chromosome)
“For those patients with isolated anemia, I want to know the genetics or, do they have a 5q deletion? Or do they have these ring sideroblasts?” Dr. Stein says. “Because that will help influence what the best treatment is.”
What About Advanced MDS?
In some cases, MDS affects all the blood cells — the red and white cells as well as the platelets — and treatment may require a more general approach than targeting a specific symptom, like anemia.
“For those patients who have not just isolated anemia, but now they’ve got pancytopenia [all blood cells are low] … that would be a patient that I think to myself, targeting and trying to fix just one of these blood cell lines isn’t going to do the trick. I need something that acts more generally on the bone marrow and that’s going to be the patient that I’m going to prioritize getting a hypomethylating agent (HMA), and that’s sort of the standard of care in that situation,” Dr. Stein says.
HMAs work by disrupting unregulated cancer cell growth. A stem cell transplant can also be considered, which is potentially curative.
The treatment will depend on the type of MDS a person has, their general prognosis, and their overall health. MDS may be treated with the following approaches:
- Disease-modifying therapies, such as chemotherapy or targeted therapy
- Supportive care, which could include blood transfusions or blood-stimulating medicines
- Blood and marrow transplants
- A combination of the above approaches
As always, your doctor can help you understand your specific disease and your unique circumstances and is in the best position to help determine the best course of action for you.
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