Myelodysplastic Syndrome

Types of MDS

There are many different types of myelodysplastic syndrome. Over the last 30 years, at least three classification systems for MDS have been created in an effort to categorize the various disease types: 

French-American-British (FAB) places MDS types into five categories. Created in 1975 and revised in the early 1980s, it is not widely used today.

World Health Organization (WHO) classification, originally created in 1999 and updated in 2008, is a modification of the FAB system which reclassifies MDS types into seven categories.

International Prognostic Scoring System (IPSS) was created in 1997 (Greenberg, et al. Blood, Vol.89, No. 6: 2079-2088, 1997). It uses a numerical score to determine a patient's risk category, derived from the percentage of blasts present in bone marrow, patient blood count and the presence of chromosome alterations.

M. D. Anderson uses the IPSS to classify MDS patients as illustrated below:

The following factors are used to calculate the IPSS score: 

The IPSS score is also used by oncologists to predict age-related survival rates and progression to acute myelogenous leukemia in MDS patients.

NR = not reached

New Prognostic Model for Low or Int-I MDS.

Estimated survival outcomes within each score range and proposed risk categories

Symptoms

There are multiple symptoms of MDS, many of them non-specific. Signs may include:

• Easy bruising
• Fatigue
• Weight loss
• Petechiae (tiny red spots just under the skin)
• Fever
• Frequent infections
• Weakness
• Shortness of breath

Having one or more of the symptoms listed above does not necessarily mean you have MDS. However, it is important to discuss any symptoms with your doctor, since they may indicate other health problems.

Causes & Risk Factors

Most cases of MDS have no known cause, but some factors have been determined to increase the risk. Advancing age is perhaps the most common risk factor, since it rarely occurs in people under the age of 60. Other risk factors include smoking, long-term exposure to benzene and prior treatment with chemotherapy or radiation.

Treatment

Over the last few years, the care of patients with MDS and the understanding of this disease have improved significantly. This has resulted in the development of new therapies.

Lower risk MDS patients are treated initially for the specific complications of the disease, such as anemia and low blood counts. If there are indications for more aggressive therapy, strategies that are now considered standard of care include the hypomethylating agents (5-azacitidine and decitabine) and lenalidomide.

Higher risk MDS patients usually need more aggressive therapy but much depends on the age and condition of the patient. Younger patients with high risk disease are considered for front-line chemotherapy approaches followed perhaps by allogeneic stem cell transplantation. For older patients, who constitute the majority, intensive chemotherapy is rarely considered. Instead, our strategy focuses on development of active and safe treatments for newly diagnosed patients as well as those who have failed the standard of care based therapies.

MDS is one of the main areas of research of the Department of Leukemia. This is demonstrated by the large number of clinical trials specific for patients with MDS and by the extensive basic and translational research exemplified by our NIH funded MDS P01 grant, now in its fourth year, to increase our understanding of the disease. Approximately 300 patients with MDS are evaluated in our center per year by a group of physicians completely dedicated to the care of these patients. This care is provided in close collaboration with the referring physicians, a key aspect for the long-term follow up of these patients who will require extensive care during the course of their MDS.

Cancer is a journey that no one needs to take alone. There are many forms of support to help you through every stage: diagnosis, treatment and survivorship. Whether you meet with other cancer survivors like yourself, use complementary therapies or individual coping mechanisms, help is available in many forms. Listed below are just some of the ways to find help...and hope.

Learn more about patient and family support programs

Support Groups

Getting together with other cancer patients in a support group is a valuable coping tool. Support groups are usually focused on a single disease or topic, such as breast cancer survivors or people coping with life-changing side effects from their cancer or cancer therapy. These groups allow participants to meet others like themselves and seek strength from each other. Most major cities and cancer hospitals offer support groups that meet weekly or monthly. There are also dozens of online support web sites or message boards for those who may not have access to a traditional meeting. 

Find a support group

Complementary Therapies

Complementary therapies are used in conjunction with cancer treatment, in an effort to reduce treatment side effects, ease depression and anxiety and help cancer patients take their mind off the negative aspects of their situation. Complementary therapies may include mind-body exercises like yoga, tai chi and Qi gong; visualization or guided imagery; using art or music as therapy and self-expression and traditional Eastern medicine such as acupuncture. 

Find complementary therapies at M. D. Anderson

Physical Activity

Staying physically active as much as possible during cancer treatment has many positive benefits. Physical activity stimulates the release of endorphins, a hormone that helps elevate mood, as well as decreasing feelings of fatigue.

Exercises for cancer patients can range from simple stretches done in the bed or chair, to more active pursuits such as walking or light gardening work. However, it’s important not to push yourself too hard. Check with your doctor before attempting any physical activity to make sure you are up to it.

Journaling/Blogging

Many people find it helpful to keep a journal of their cancer treatment experience. It may be as simple as recording symptoms and side effects into a notebook, or may include personal emotions and opinions about what they may be going through. Journals can be private, like a diary, or shared with loved ones and even strangers. 

Increasingly, people are turning to the Internet to share their cancer journey with the world at large and to seek out others with similar experiences. Many cancer patients have begun their own web log, or “blog” to publicize their battle with cancer. Twitter, a mini-blogging technology that limits posts to 140 characters, has also proven to be a helpful tool for cancer patients to keep friends updated and reach out to others.