Treatment Options

this discussion of MDS treatment options is so clear!

i like the statement that it's not if you get a BMT but when!

some of the statements main are contradicted by other websites

"Planning Treatment for MDS
"Since a stem cell transplant utilizing cells from a donor, called an allogeneic stem cell transplant, holds the most hope for cure, a major decision faced by patients with MDS is not whether to undergo transplantation, but when. Patients with MDS that is likely to progress to leukemia early--which results in shorter survival--may be willing to accept higher risks of treatment and proceed quickly to a stem cell transplant.

"Patients with MDS that progresses more slowly are likely to live longer and may wish to pursue a more conservative treatment approach, opting to use supportive care and wait a longer period before undergoing a stem cell transplant.

"However, patients who choose conservative treatment approaches should always be prepared to receive more aggressive treatment in case their disease progresses more rapidly than anticipated. To prepare for a possible stem cell transplant, patients should consider arranging for a stem cell donor and/or having their own stem cells collected and stored shortly after diagnosis. This is important because as MDS progresses and treatment is initiated, it becomes increasingly difficult to collect stem cells.

"In order to better plan treatment, doctors try to identify how quickly patients are likely to progress to acute myeloid leukemia (AML). A score is assigned that reflects this tendency to progress, and is based on a system called the International Prognostic Scoring System (IPSS). A higher score is associated with a type of MDS that is likely to progress to leukemia more quickly.

"The IPSS score takes into account three important factors in MDS:

1. The percent of bone marrow blasts, more blasts contributes to a higher score Genetic abnormalities, more abnormalities contribute to a higher score
   
2. Severity of low white blood cell counts, lower counts of white blood cells, platelets, and red blood cells contribute to a higher score 
   
3. Relationship between a patient's risk of progressing to leukemia and timing of stem cell transplant:

"Research shows that knowing a patient's risk of progressing to leukemia is important for determining optimal timing of stem cell transplantation.

"Based on information about 1,000 patients who had been diagnosed with MDS, researchers from several U.S. cancer centers have determined that patients with a low or low-intermediate risk of progression to leukemia have better outcomes if their transplant was not performed at the time of diagnosis, but was delayed. Patients with a high or high-intermediate risk experienced optimal survival if they underwent an allogeneic transplant at the time of diagnosis, without delay.

"Furthermore, the patients with lower risk achieved optimal outcomes if their transplant was administered prior to progression of their disease to acute myeloid leukemia compared to after progression. Overview of Treatment of MDS: The objective of treatment is to control the growth of the abnormal cells so that more normal cells can grow and improve blood cell production. Some treatments are designed to manage the complications associated with ineffective blood cell production, while others extend survival or even cure the disease.

"Treatment of MDS is individualized and depends on two main factors:

• The severity of low blood counts
  
• The risk of progression to acute myeloid leukemia

"Other factors that influence treatment decisions include patient's age, other medical conditions, and the severity of the myelodysplastic syndrome.

"The potential treatment options for MDS include the following:

• Supportive Care for MDS: Blood Cell Growth Factors
• High-Dose Therapy with Stem Cell Transplant for MDS
  
• Chemotherapy without Stem Cell Transplant for MDS Vidaza (azacitadine), 
• Targeted Therapy for MDS, 
• Revlimid (lenalidomide)
  

"Strategies to Improve Treatment of MDS Currently, only stem cell transplant utilizing cells from a donor, called an allogeneic transplant, can consistently cure patients with MDS. Other therapies are directed at prolonging survival and decreasing the symptoms from these diseases.

http:// patient.cancerconsultants.com/ CancerTreatment_Myelodysplastic_Syndrome.aspx?LinkId=53983

i can't be sure where i got the next 2 articles - sorry take it or leave it as is til i find th reference.
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.