MDS, or myelodysplastic syndrome, is a collection of conditions that can occur when blood-forming cells in the bone marrow become damaged. Some of these conditions are mild and simple to manage, while other, more aggressive forms can develop into acute myeloid leukemia (AML), a cancer in which immature blood cells grow uncontrollably. Regardless of the type of MDS a patient has been diagnosed with, expert management of the condition is essential.
What causes MDS?
Most cases of myelodysplastic syndrome--about 80 to 90%--do not have an identifiable cause.These cases are referred to as primary or de novo MDS. However, cellular damage from chemotherapy or radiation treatment for a previous cancer may contribute to secondary MDS, or MDS with an established cause.
Researchers have also identified several risk factors for MDS, or factors that may increase the likelihood of developing this syndrome. These include:
- Older age, as most people diagnosed with MDS are in their 70s or 80s
- Exposure to certain industrial chemicals, tobacco smoke, high levels of radiation or heavy metals
- Certain inherited genetic syndromes, including familial platelet disorder, Fanconi anemia and Shwachman-Diamond syndrome
How many types of MDS are there?
The World Health Organization (WHO) currently recognizes six main myelodysplastic syndromes:
- MDS with isolated del chromosome abnormality
- MDS with excess blasts
- MDS with single lineage dysplasia
- MDS with multilineage dysplasia
- MDS with ring sideroblasts
- Unclassifiable MDS
MDS subtypes are categorized based on several factors, such as how many red and white blood cells appear abnormal under a microscope (dysplasia), the amount of very early blood cells (blasts) in the bone marrow or blood and blood cell counts. Additionally, chronic myelomonocytic leukemia and juvenile myelomonocytic leukemia may also be recognized as mixed myelodysplastic/myeloproliferative diseases.
What are the signs and symptoms of MDS?
Myelodysplastic syndrome may not produce noticeable symptoms in its early stages, or ever. Over time, some people with MDS may experience:
- Unusually pale skin
- Shortness of breath
- Easy bruising or bleeding
- Weight loss
- Reduced appetite
- Tiny red spots underneath the skin (petechiae)
A key sign of MDS is low blood cell counts, which may be discovered in a blood test before noticeable symptoms develop. When symptoms do occur, they are often related to MDS complications rather than the condition itself. Commonly seen complications of MDS include:
- Anemia -- A shortage of red blood cells that can cause dizziness, weakness, fatigue and pale skin
- Thrombocytopenia -- A deficiency of blood platelets that may lead to easy bruising and bleeding
- Leukopenia -- A lack of healthy white blood cells which can increase the likelihood of frequent and severe infections
Another major complication of MDS is a blood cancer called acute myeloid leukemia (AML). It’s estimated that about one-third of MDS cases eventually progress to AML. For this reason and others, it’s critical to promptly speak with a medical professional if potential MDS symptoms develop.
How is MDS treated?
Treatment for myelodysplastic syndrome often focuses on alleviating symptoms, preventing serious complications and improving quality of life. A stem cell transplant is generally considered to be the only curative option for MDS, although some young and otherwise healthy patients with mild symptoms may be able to take a watchful waiting approach to treatment.
Regardless of the prognosis, personalized care is critical to the success of MDS treatment. MDS is a complex condition with multiple subtypes that can affect people in different ways. An effective treatment plan must be tailored to the patient’s specific MDS subtype as well as his or her symptoms, age and overall health.
Our approach to MDS treatment
Moffitt Cancer Center’s Malignant Hematology Program, which has one of the largest MDS treatment programs in the nation, provides comprehensive, individualized and multispecialty care for patients with all forms of MDS and AML. We understand that each patient responds differently to therapy, so our experienced team of oncologists, hematologists, medical oncologists, supportive care providers and other medical professionals thoroughly assesses each patient’s case to determine the most appropriate options for working toward remission and bringing blood cell counts as close to normal as possible. A patient’s unique treatment recommendation might include a combination of the following MDS therapies:
- Targeted therapy
- Stem cell and bone marrow transplants
- Blood transfusions
- Clinical trials
At Moffitt, all MDS therapies are provided in a single location, making it easier for our patients to access the outstanding treatments they deserve without the stress of traveling from clinic to clinic. Furthermore, we also offer a complete range of supportive care services, such as side effect management and psychosocial counseling, giving our patients a convenient way to improve their quality of life during treatment.
Not only is Moffitt a recognized leader in MDS treatment, but we are also committed to learning more about these conditions and how they can eventually be cured. With a dedicated research team working hand in hand with our expert oncologists, Moffitt is paving the way for better MDS treatment options and patient outcomes. For these efforts, we have been named a Comprehensive Cancer Center by the National Cancer Institute–the only such center based in Florida. Our Malignant Hematology Program has a robust clinical trials program and has contributed to the approvals of several innovative drugs for MDS treatment.
Medically reviewed by David Sallman, MD, Malignant Hematology.