Myelodysplastic Syndrome

Myelodysplastic syndrome (MDS) is a group of disorder (syndrome), characterized by abnormality in the bone marrow leading to deficiency in healthy blood cells.

This condition is considered as a cancerous state of the bone marrow, and about one third of this cancerous growth develops acute myeloid leukemia (blood cancer).

The bone marrow produces the blood cells. The mother cells known as the stem cells which develop in the bone marrow undergo maturation to form healthy blood cells (red blood cells, white blood cells, and platelets). However, in this condition the stem cells do not mature and remain in the bone marrow (myelodysplasia).

Condition of cytopaenia, (which is low blood count) is seen in:

1. Anaemia: Low red blood cell count
2. Leukopaenia: Low white blood cell count
3. Thrombocytopaenia: Low platelet count
4. Pancytopaenia: Deficiency of all blood cells

Hence confirmation by blood tests, bone marrow biopsy study (needle inserted into the pelvic bone and fluid is withdrawn) and chromosomal study of the cells is done.

Statistical Insights in MDS

Mainly, the older age group is affected, but sometimes, younger age group affection can also be seen. Incidence of MDS is 3 to 4 cases per 100,000; in older age group (>=65) the incidence peaks to 30:100,000.

Risk factors for MDS

MDS is classified into two types depending on the cause, these are:

• Primary MDS does not have any cause.
• Secondary MDS is a result of below mentioned risks:
  1. Chemotherapy: Treatment of cancers using chemicals to kill cancer cells may lead to MDS. Chemotherapy given for stem cell transplant patients also exposes the patient to MDS.
  2. Heredity: Genetic causes with inherited genes
  3. Familial MDS: More frequent occurrence in some families
  4. Smoking
  5. Environmental factors: Radiation and chemical exposure (occupational hazards of benzene etc.)
  6. Viral infection
  7. Age: More common in older age group
  8. Sex: More common in men

If the avoidable risk factors are taken care of (like smoking) prevention of MDS is possible.

Signs and Symptoms

Patients might have no symptoms at all in the early stages, apart from the decrease in the cell count. If the cell count goes way below normal, then the symptoms related to that particular deficiency occurs, such as:

1. Anaemia: Pale skin, shortness of breath, and palpitations. Fatigue and even chest pain in older patients
2. Leukopaenia: Recurrent infections of the sinuses, lung or skin
3. Thrombocytopaenia: Minor injuries tend to bruise and bleed easily such as bleeding gums

Risk Groups of MDS

Depending on the blood picture MDS is grouped under different risk categories : Very low, low, intermediate, high, and very high. This is known as prognostic scoring of MDS.

Mean survival rate for low risk patients is 18-24 months and for high risk is 6-12 months.

MDS Treatment

Factors such as age and general health of the patient, and type of MDS help determine the treatment plan, which includes:

• Growth factors: These are hormone like substances which help to stimulate the bone marrow to produce mature blood cells.
• Chemotherapy: Conventional or immunomodulatory drugs (chemicals) to kill abnormal stem cells.
• Supportive therapy: Blood and platelet transfusion. Detection and treatment of infections.
• Stem cell transplant: This is the only treatment that can cure MDS.
  • oAllogenic stem cell transplant (stem cells from the donor) is the preferred method and the success rate is more if the stem cells from the donor closely match the patient Another option for older patients is low doses of chemotherapy followed by special type of stem cell transplant called as non-myeloablative allogenic stem cell transplant (mini transplant)
• Immunotherapy: Biologic treatment to increase the body’s defense system is also used, though rarely. This is usually given after chemotherapy. A wide range of immunotherapy drugs are available and so it is best to discuss different options with your doctor.
• A combination of the above treatments is used to achieve the maximum goal to treat patients with MDS.

Postoperative care for MDS

The patient has to under the care of a haematologist (specialist on blood related disorders).

Complication of stem cell transplant can be rejection of the donor cells.

Despite the best plan, MDS can worsen, hence talking to your doctor and palliative care is helpful.

Remission and recurrence can be a possibility, so it is better to understand your risk and treatments.

Cost of MDS treatment in India

The cost of myelodysplastic syndrome treatment in India starts from USD 15,000.