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Myelodysplastic Syndromes
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There are several myelodysplastic syndromes that are caused by dysfunctional or poorly made blood cells. It happens when something goes awry in the bone marrow so that cells coming from it do not turn out the way they are supposed to. Myelodysplastic syndromes have no cure but there are treatments that can be done to alleviate the symptoms and make the individual feel better. In some cases, bone marrow transplants are done to replace bad marrow with good marrow.
In the early stages of myelodysplastic syndromes, there are few, if any, symptoms. As the diseases progress, they can lead to shortness of breath, anemia, fatigue, pale skin, petechiae (pinpoint bleeding spots) and recurrent or frequent infections.
The cause of myelodysplastic syndrome involves an insult to the bone marrow that interrupts its ability to make normal cells. The cells can then die within the confines of the bone marrow or can die shortly after leaving the bone marrow and entering the bloodstream. There are two types of myelodysplastic syndrome, including those caused by radiation and chemicals. This is also called secondary myelodysplasia. There are also myelodysplastic syndromes that have no specific cause. This type of myelodysplastic syndrome is more easily managed than secondary myelodysplasia.
The various types of myelodysplastic syndromes include several subtypes, including:
- Refractory anemia with ringed sideroblasts. The red cells that persist have a ring of iron around them.
- Refractory cytopenia with unilineage dysplasia. The red blood cells are usually the cells affected with other cell types in the blood unaffected.
- Refractory cytopenia with multilineage dysplasia. In this type, platelets, red blood cells and white blood cells are affected.
- Refractory anemia with excess blasts. This can involve any type of blood cell and the blood cells come out immature.
- Myelodysplastic syndrome, unclassified. There are reductions in all types of red blood cells and at least one of these types has an abnormal appearance under the microscope.
- Myelodysplastic syndrome with isolated del(5q) abnormality. In this case, a specific chromosomal defect has been found and the defect is mostly in the red blood cells.
You have a greater risk of developing a myelodysplastic syndrome if you are older than sixty years of age, if you are male, if you have had previous chemotherapy or radiation, if you have been exposed to tobacco smoke, benzene or pesticides, or if you have been exposed to heavy metals such as mercury and lead.
There are several complications with myelodysplastic syndromes including recurrent infections from poor white blood cells or reduced numbers of white blood cells, anemia secondary to low red blood cell count or bleeding from a low platelet count. Occasionally, people with myelodysplastic syndromes come down with secondary leukemia-or cancer of the bone marrow.
Tests for myelodysplastic syndromes include blood tests in which the total numbers of cells are counted and the cells are looked at to see if there are abnormalities of the cells. This can be done using a peripheral blood smear. Doctors can also do a bone marrow analysis to see what cells are being put out by the bone marrow and what those blood cells look like.
There is no complete cure for myelodysplastic syndromes. There is good supportive care, however, which can make a person with a myelodysplastic syndrome feel better. This can include blood transfusions which can replace red blood cells, platelets or white blood cells when the count is too low.
Medications are used in some cases, which include growth factors that increase the number of cells made. This includes erythropoietin and darbepoietin. Medications are available that stimulate the maturation of red blood cells or other cells. These include Vidaza and Dacogen. It can help delay the progression of the disease to leukemia. Immunosuppressors can be used to block the immune systems actions on myelodysplastic syndromes. There are specific medications for those myelodysplastic syndromes associated with a specific genetic abnormality.
Some people can get a bone marrow transplant or a stem cell transplant. Chemotherapy destroys your sick bone marrow and then healthy bone marrow is infused into the blood where it travels to the bone marrow to take up what the old cells used to do. It is a risky procedure to do, even in the healthiest of people.