‘Myelodysplastic syndromes’ (aka myelodysplasia or MDS) are a bit of a mouthful. The phrase describes a group of cancers affecting the blood. In myelodysplastic disease, the bone marrow (the central ‘filling’ of bone) produces abnormal blood cells. Normally, healthy bone marrow is responsible for making the majority of the cells floating through your bloodstream. These include the cells responsible for carrying oxygen, forming blood clots and fighting off infections. These cells are produced from stem cells, special cells capable of producing cells of any type when they divide.
However, with MDS, the bone marrow fails to produce healthy versions of these cells, due to a defect or damage to its stem cells and produces immature cells instead. The abnormal cells produced instead do not do their job properly and accumulate in the blood, which is one way of first detecting this group of diseases. A sample of blood is taken and the number of blood cells are measured. Next, the improperly developed cells are looked for.. The number and ratio of these immature blood cells may inform of the progression or type of the disease affecting the bone marrow.
Molecular analysis can help to identify the specific subtype of disease and may guide treatment further down the line.
How does MDS affect you?
Because the cellular content of the blood is working less well, people who are developing MDS will bleed, or get tired or short of breath easily. Because of the immune role of some of these blood cells, people with MDS are also more at risk of infections and are less able to fight simple diseases off. Some subtypes of MDS affect only one cell type (say the red blood cells, which carry oxygen) and develop slowly, others may affect all cell lines and act very quickly.
Almost a third of people with MDS will also go on to develop acute myelodysplastic leukaemia (AML), a subtype of blood cancer affecting the white blood cells. AML is an aggressive form of leukaemia with similar symptoms to MDS. As with MDS, too many immature white cells are produced. These cells do not carry out their proper function and won’t effectively fight off infections, at the same time as ‘diluting’ the remaining cellular content of the blood.
What may increase the risk of MDS?
MDS are primarily diseases of the elderly. Most people affected are above the age of sixty and it is uncommon to see these disorders developing in younger people. There is a greater occurrence of these subset of diseases in those exposed to industrial chemicals from the rubber and petrochemical industries, though many cases are not linked to these triggers and have no associated ‘cause’. Previous radio or chemotherapy for cancer has also been shown, in rare instances, to produce MDS later in life.
How is MDS treated?
When MDS is identified, it is stratified by risk of transforming into cancer. This can help plan for treatment. Treating MDS is done through either the usual methods of managing premalignant and early malignant disease; chemotherapy and radiotherapy – or through supportive measures such as blood transfusions to provide healthy blood cells and antibiotics to manage infections.
Drug treatment options slow the progression of MDS to more aggressive cancers. The use of agents such as Lenalidomide, Azacitidine and Decitabine and immunosuppressive drugs will either slow cell processes or reduce the need for other supportive measures such as transfusion or stem cell therapy.
Some of these treatment regimens may use bone marrow transplants. This is where healthy bone marrow is given by matched donors to their counterparts with disease. This can provide a long lasting cure for sufferers of MDS, provided that their donor is a correct match. The odds of this are quite long; even your siblings may not be a close enough match. This is why it is important for organisations such Anthony Nolan to maintain a register of potential donors. When someone joins, their HLA groups (the proteins on the surfaces of cells which decide which immune group you’re in) are stored in a database. If they match with someone who needs bone marrow, they are contacted and asked to come in. All it takes to sign up is a spit sample. I know a handful of people who have been called up; all of them assure me that it is worthwhile and not scary! I urge you to consider it!
If you’re interested in joining the bone marrow register, here is a guide.
To learn more about MDS, visit www.mdspatientsupport.org.uk
Sources and Further Reading
- Kumar P, Clark M. Clinical Medicine. Seventh Ed. 2009. Saunders Elsevier.
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Any opinions above are the author’s alone and may not represent those of his/her affiliations. Any comment is based on the best available evidence at the time of writing. All data is based on externally validated studies unless expressed otherwise. Novel data is representative of the sample surveyed. An online recommendation is no substitute for seeing your own doctor and should not be taken as medical advice. Article proofed and edited for publication by Dr. BM Janaway.