Candian Treatment Discussion

How is MDS Treated?
from http://www.neutropenia.ca/research/mds.html#treated

Treatment for MDS depends on two main factors: the degree to which blood cell counts are reduced, and the risk of progression to AML.
{{{{i don't know my risk factors yet. i'm at least intermediate 1 by the international system.}}}}}}}}
Induction Chemotherapy In the high-risk group and the intermediate-risk group II, there is a high rate of progression to AML. These patients should consider receiving intravenous chemotherapy. Relatively strong doses of chemotherapy are given to "induce" control of the disease. One temporary side effect of inductive chemotherapy is further failure of the bone marrow.

Initially, chemotherapy kills the bone marrow cells that normally produce platelet and red and white blood cells. This phase lasts several weeks, during which the patient remains hospitalized, receiving red cell and platelet transfusions along with antibiotics to fight infection. Because chemotherapy kills dividing cells elsewhere in the body, not just in the bone marrow, patients experience hair loss, mouth sores, and often diarrhea.

If induction chemotherapy manages to control the myelodysplastic cells, then relatively normal cells should grow. Within several weeks there will be enough red cells and platelet produced in the marrow to require fewer transfusions. Meanwhile, the white cell count should also rise, lessening the risk of infection. Unfortunately, the chance of controlling MDS with induction chemotherapy is only about 30%. Even in successful cases, the disease often returns within twelve months. Thus aggressive chemotherapy is given to a minority of MDS patients.
Red Cell Transfusion
{{{{{{{this is really just supportive cuz it doesn't extend life expectancy }}}}}}}}}
Patients in the low-risk group or intermediate-risk group-1 may not be producing enough red blood cells, in which case they are given supportive treatment in the form of transfusions. If patients are quite anemic (hematocrit consistently less than 25%) they will receive periodic transfusions, typically two units every two to six weeks. In older patients, there is some risk of shortness of breath from excess fluid received during transfusion. This can often be avoided or minimized by intravenous administration of the diuretic Lasix.

 {{{{{{{so far my red blood cells are pretty close to normal }}}}}}

Vitamin Therapy Vitamins have been an active area of MDS research over the past two decades. In test tubes, myelodysplastic cells often normalize when exposed to vitamins such as D3 and A (retinoic acid). Overall, however, clinical trials have been disappointing.

Presently a major area of research is devoted to combining vitamins with low doses of chemotherapy and/or growth factors such as erythropoietin and GM-CSF. It may be worth asking your specialist about any ongoing studies.

Bone Marrow Transplantation Bone marrow transplantation is becoming more effective as therapy, particularly for AML. The ultimate goal of transplantation is to cure patients by completely eliminating their myelodysplastic cells. To date, about 500 MDS patients have undergone bone marrow transplantation. Almost all have been under the age of 40.

In patients over the age of 55, the risks of transplantation clearly outweigh the benefits, given the high risk that the donated marrow (graft) will reject the patient (host). Because MDS is a disease of the elderly, bone marrow transplantation doesn't represent a viable option for most patients.

In addition to being young enough, candidates for transplants must have a sibling who is the same transplantation type. That is, there must be an HLA match between the two. HLA type - not to be confused with blood type - is determined through a blood test. Unfortunately, children and parents of the patient do not qualify as HLA matches.

Even in younger patients, bone marrow transplantation is a high-risk procedure. Within the first year there is a 30 to 50% chance of dying from transplant complications, either graft vs. host disease, or damage to the liver or lungs. Patients who survive these complications, however, have a good chance of being cured.

There is clearly no right answer to the question of whether patients under the age of 55 who have an HLA match should undergo transplantation. For people without other major medical problems, certainly the risks of life-threatening transplant complications are lower than the risks of delaying, or not receiving, a transplant.