What is myelodysplastic syndrome (MDS)?
Myelodysplastic syndrome or MDS is a group of diverse bone marrow disorders in which the marrow does not produce sufficient healthy blood cells. In MDS, cells in the bone marrow are dysplastic. These defective cells die earlier than normal cells. MDS is known as bone marrow failure disorder. Though MDS can affect red blood cells, white blood cells and platelets; the most common type of MDS is shortage of red blood cells known as myelodysplastic anemia.
MDS affects the elderly as well as young people. MDS is considered a precursor to cancer as 1 in 3 patients can go on to develop acute myeloid leukemia (AML).
MDS is classified using the World Health Organization (WHO) classification system which was updated in 2016. It divides MDS based on cell morphology as well as other features.
- Forms of cell types (RBCs, WBCs, Platelets) which show dysplasia
- Types of low cell counts which a patient presents
- What portion of red blood cells are ring sideroblasts
- Chromosomal changes in the bone marrow cells
Based on this classification, there are six major types of MDS:
- MDS with multilineage dysplasia (MDS-MLD)
- MDS with single lineage dysplasia (MDS-SLD)
- MDS with ring sideroblasts (MDS-RS)
- MDS with excess blasts (MDS-EB)
- MDS with isolated del(5q)
- MDS, unclassifiable (MDS-U)
- Fatigue and unusual tiredness
- Shortness of breath
- Frequent infections due to low WBC count
- Easy bruising due to low platelet count
- Red spots just beneath the skin (petechiae)
- Blood tests – complete blood count
- Bone marrow biopsy – where a thin needle is used to aspirate (withdraw) a small amount of bone marrow fluid from the back or hip. The sample is tested in the lab for abnormalities
- A number of medications are available to manage the condition, suppress symptoms and prevent complications. These include:
- Drugs to increase the blood cells (growth factors) like erythropoietin (to increase RBCs), filgrastim (to increase WBCs)
- Drugs to stimulate maturation of red blood cells like azacitidine and decitabine
- Drugs to suppress the immune system which can lessen the need for regular blood transfusions
- If the MDS is associated with a gene mutation called isolated del95q), a medication called lenalidomide is given
- In most cases, regular red blood cell, white blood cell or platelet transfusions may be needed on a regular basis