11. Supportive Care in Myelodysplastic Syndrome

  1. Hussain I. Saba MD, PHD2 and
  2. Ghulam J. Mufti MB, DM, FRCP, FRCPATH3
  1. Hussain I. Saba MD, PHD2,
  2. Arshia A. Dangol1 and
  3. Donald C. Doll1

Published Online: 24 MAR 2011

DOI: 10.1002/9781444394016.ch11

Advances in Malignant Hematology

Advances in Malignant Hematology

How to Cite

Saba, H. I., Dangol, A. A. and Doll, D. C. (2011) Supportive Care in Myelodysplastic Syndrome, in Advances in Malignant Hematology (eds H. I. Saba and G. J. Mufti), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444394016.ch11

Editor Information

  1. 2

    James A. Haley Veterans' Hospital, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida College of Medicine, Tampa, FL, USA

  2. 3

    Department of Haematological Medicine, Guy's and St Thomas' School of Medicine, King's College Hospital, London, UK

Author Information

  1. 1

    James A. Haley Veterans' Hospital, and H. Lee Moffitt Cancer Center and Research Institute, University of South Florida College of Medicine, Tampa, Florida, USA

  2. 2

    James A. Haley Veterans' Hospital, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida College of Medicine, Tampa, FL, USA

Publication History

  1. Published Online: 24 MAR 2011
  2. Published Print: 16 APR 2011

ISBN Information

Print ISBN: 9781405196260

Online ISBN: 9781444394016

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Keywords:

  • Myelodysplastic syndrome;
  • pancytopenia;
  • pre-leukemia;
  • supportive care;
  • MDS;
  • transfusion;
  • growth factors;
  • G-CSF;
  • GM-CSF;
  • platelet growth factor;
  • iron overload

Summary

Myelodysplastic syndrome (MDS) is a group of heterogeneous stem cell disorders characterized by ineffective hematopoiesis resulting in anemia, neutropenia, and thrombocytopenia. Cytopenias and their complications in MDS can be monolineage or multilineage in presentation, and can occur de novo (without any apparent cause) or secondarily resulting from a mutagenic exposure such as chemotherapy, benzene, or other chemicals. Chromosomal abnormalities are common in approximately 40-70% of cases in de novo MDS and in almost 95% of secondary MDS cases. MDS can be further divided into low risk and high risk. In low-risk MDS, the pathogenic mechanism appears to be ineffective hematopoiesis. Therefore, management has been directed to improve or correct the cytopenias in low-risk MDS patients. In the high-risk MDS group, the goal has been to delay or stop the transformation and progression of the disease to acute leukemia, which can happen in approximately one-third of adult MDS patients. So far there has been no cure for MDS except for bone marrow transplant, which is available for only a minority of patients, as this remains a disease of the aged. Best supportive care, therefore, remains the most viable option in the management of these patients. Red cell transfusion support has been used the most frequently for the management of MDS-related anemia, but it is not without its complications (e.g., iron overload). The availability of erythroid growth factor has been an important asset in the management of anemia. Management of iron overload with iron chelation has provided important support as well. The management of neutropenia and infection with antibiotics and myeloid growth factor(s) has played an important role in prolonging the lives of MDS patients. Thrombocytopenia and related bleeding have been traditionally managed with platelet transfusions due to unavailability of suitable platelet growth factor(s). Currently, new platelet growth factors are under investigation and could become useful for management of thrombocytopenia of MDS in the future. Availability of some therapeutic agents (e.g., cyclosporine, ATG) and, most recently, the use of agents such as thalidomide and its derivative Revlimid, hypomethylating agents such as 5-azacytidine (Vidaza) and 5-aza-deoxycytidine (Decitabine, Dacogen) have been important tools of support in this most common malignancy of the elderly.