How Do You Treat Therapy-Related Myelodysplastic Syndrome?

Myelodysplastic syndrome is a group of disorders that determine low production of healthy blood cells due to defective bone marrow. The blood cells that are produced in this process are immature and cannot perform their basic function. These cells grow in abnormal number that may damage the healthy blood cells and progress to a cancerous state. This disorder develops due to mutations in the DNA of blood cells. Few cases of myelodysplastic syndrome develop due to prior radiation therapy or chemotherapy done for acute lymphocytic leukemia, Hodgkin or non-Hodgkin leukemia. The therapy-related myelodysplastic syndrome can be treated with chemotherapy and bone marrow transplantation.

How Do You Treat Therapy-Related Myelodysplastic Syndrome?

Myelodysplastic syndrome or MDS is a bunch of disorders that impair the functioning of bone marrow. The main function of bone marrow is to make new red blood cells, white blood cells and platelets. With the faulty bone marrow, immature blood cells circulate in the blood and the problems like anemia, low cell counts and other problems arise. In this condition, the body is unable to eradicate these immature blood cells which it can do efficiently in the healthy state. It occurs more in men than in women. Its appearance is noted at the age of 60 years. It is rarely seen in children.

Myelodysplastic syndrome usually has the previous history of acute lymphocytic leukemia. It occurs due to exposure to radiation therapy or chemotherapy performed for the treatment of leukemia. It happens after 1 to 15 years of these therapies.

The therapy-related myelodysplastic syndrome can be treated through two methods, chemotherapy and bone marrow or stem cell transplantation. A class of chemotherapy drugs may relieve the symptoms of myelodysplastic syndrome in a modest manner. It includes hypomethylating agents such as Vidaza and Dacogen. It needs supportive therapy to tackle problems related to blood cells. Blood and platelet transfusions are done as supportive therapy to elevate the levels of red blood cells and platelets according to the requirements of the patient. Iron chelation therapies are also used in these cases to overcome the risk of iron overload. The hypomethylating agents are useful in cases where frequent blood transfusion is needed.

Revlimid is an FDA approved growth factor used to treat myelodysplastic syndrome that have an isolated cytogenic abnormality of chromosome 5. It is not effective in all cases. It treats only the cases where myelodysplastic syndrome is Revlimid sensitive disease. Its activity in therapy-related myelodysplastic syndrome is modest.(1)

Bone marrow transplantation or stem cell transplantation is the ultimate way to cure myelodysplastic syndrome especially therapy-related myelodysplastic syndrome. It is a procedure in which new bone marrow or stem cells replaces faulty bone marrow or stem cells. Allogenic bone marrow is extracted from the matched donor. It is preferred from the close relative of the patient. However, it is a possible curative option of this type of myelodysplastic syndrome, but it is not always safe in every case of myelodysplastic syndrome in every age or with other medical illness.

Stem cells are extracted from the blood of the donor through a machine and the rest blood is returned back to the donor. The patient then receives chemotherapy or radiation therapy to destroy immature blood cells or cancer cells in the blood. It is also done to make room for new stem cells during transplantation.(1)

Stem cells are then injected into the bloodstream of the patient through IV. It is done through a catheter positioned in the blood vessel in the chest. The injected stem cells reach bone marrow and start to produce new healthy blood cells. The doses are kept low to avoid side effects such as fever, hives, pain, etc.

Conclusion

Therapy-related myelodysplastic syndrome develops after 1 to 15 years of radiation therapy or chemotherapy received for leukemia. It can be treated with a class of chemotherapy drugs in a modest manner. Bone marrow or stem cell transplantation is the most curative mode of treatment for therapy-related myelodysplastic syndrome.

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