Myelodysplastic syndromes

Myelodysplastic syndromes (MDS) are a group of conditions where the bone marrow stops working properly and does not make enough normal blood cells.

The blood cells the bone marrow does make are abnormal and not fully developed (immature). This results in the number of healthy blood cells in the bloodstream being reduced, which eventually causes symptoms.  MDS is classed as a type of cancer, and there are different types of myelodysplastic syndromes.

Some develop slowly, while others develop quickly and have a greater risk of changing into leukaemia. At London Haematology, we are experts at diagnosing, monitoring and treating all types of myeloproliferative disorders. All our care and support is provided in the first-class environments in The London Clinic, which feature state-of-the-art technology and the latest equipment.

An expert multidisciplinary team will also support you from your first consultation, during your treatment and throughout your recovery.

Causes

In most cases, it is not known why MDS develops. This is called primary MDS. A small number of people do develop MDS after treatment with chemotherapy or radiotherapy. This is called secondary or treatment-related MDS (t-MDS).

There are also risk factors that may increase your chance of developing MDS. These include:

•    Age – the typical age that people develop MDS is around 75. About 9 in 10 people with MDS are aged over 50.
•    Sex – men are slightly more likely than women to be diagnosed with MDS.
•    Inherited disorders – very rarely, MDS can be inherited or may develop from another rare blood disorder.
•    Exposure to benzene – exposure to the toxic chemical benzene may marginally increase your risk of developing MDS. Benzene is used in the rubber industry and found in petrol and tobacco smoke.

Symptoms

Symptoms depend on the type of MDS a person has. Typically, they are mild at first and slowly get worse. If you do have a myelodysplastic syndrome, you may experience one or more of the following symptoms:

•    Feeling weak and tired because of a low number of red blood cells (anaemia)
•    Feeling breathless because of a low number of red blood cells (anaemia)
•    Frequent infections because of a low white blood cell count
•    Bruising and bleeding easily, such as nosebleeds, because of a low number of platelets
•    Pain or discomfort in your belly because of an enlarged spleen

Diagnosis

At London Haematology, your expert consultant will first discuss with you your health history and carry out a physical examination. You may then undergo the following tests:

•    Blood tests to check for abnormal cells and numbers of red blood cells, white blood cells and platelets

•    Bone marrow tests to check for abnormal cells

These tests will also help your haematologist to identify the specific type of MDS you have. The six main types are:

• MDS with single lineage dysplasia (MDS-SLD)
  Only one type of blood cell has become abnormal.
• MDS with multilineage dysplasia (MDS-MLD)
  Two or more types of blood cell have become abnormal.
• MDS with ring sideroblasts (MDS-RS)
  Some of the cells in the bone marrow have a ring of iron in them. These cells are called ring sideroblasts.
• MDS with excess blasts (MDS-EB)
  There are a higher than normal number of blast (immature) cells in the blood and bone marrow.
• MDS associated with isolated del (5q)
  The cells in the bone marrow have a chromosome change called isolated del (5q).
• MDS unclassified (MDS-U)
  MDS-U covers any type of MDS which does not fit into any of the above categories.

Treatments

Depending on your type of MDS, symptoms and general health, you may not need treatment for your myelodysplastic syndrome. Instead, you may be put on ‘watch and wait’ and carefully monitored by your healthcare team at London Haematology.

If treatment is recommended, this may be used to help with symptoms or manage your MDS. Treatment is less commonly used to try to cure the condition.

Treatments for myelodysplastic syndromes include:

•    Blood or platelet transfusion
•    Growth factor drugs to increase red and white blood cell count
•    Chemotherapy
•    Stem cell therapy
•    Targeted therapies
•    Immunosuppressants