MDS After Chemotherapy Treatment

MDS, or Myelodysplastic syndrome, is one of several diseases that can affect blood and bone marrow. There are two types of MDS, primary MDS and secondary MDS. Primary MDS can range from mild to severe, with severe forms developing into a leukemia called acute myelogenous leukemia. Chemotherapy and radiation cause of the other type of MDS: secondary MDS. Secondary MDS tends to be much more severe than primary MDS; the abnormalities in the chromosomes are more severe and the prognosis is usually fairly poor.

What is MDS

• MDS affects the bone marrow (the tissue in the bones where cells are stored). Normally, immature cells (called stem cells) remain in the bone marrow as they go through a process called hematopoiesis. During hematopoiesis, the immature cells develop into either white blood cells, red blood cells or platelets. In MDS patients, hematopoiesis doesn't occur correctly. As a result, immature cells (called blasts) and abnormal cells (called dysplastics) are released into the blood. The number of normal cells decreases, lowering blood cell count and resulting in a number of adverse symptoms.

Secondary MDS

• Secondary MDS is caused by radiation or chemotherapy, usually administered as treatment for another type of cancer. Secondary MDS can develop between two and ten years after the exposure to the chemotherapy drugs and radiation. According to the Atlas of Genetics and Cytogenetics in Oncology and Haematology, the most common drugs associated with the development of secondary MDS include anthracyclins, alkykating agents and epipodophyllotoxins.

Symptoms

• Symptoms include anemia, weakness or fatigue, a tendency to bruise or bleed easily, and frequent fever of infection. If you have undergone chemotherapy or radiation and begin to experience any of these symptoms, it is essential to discuss them with your doctor to rule out secondary MDS.

Treatment

• Treatment varies depending on the condition and needs of the patient. Because the prognosis is poor for secondary MDS, many patients choose only supportive care. Supportive care involves treatments for the symptoms of MDS, as opposed to treatments for the disease. This can include blood transfusions to raise blood cell count (to help stave off infection, or reduce fatigue or other symptoms) and/or platelet transfusions to help manage bleeding and bruising.

  Chemotherapy may be an option to treat the disease itself. Chemotherapy is designed to kill cancer calls. Only 30 to 40 percent of all MDS patients (those with both primary MDS and secondary MDS caused by chemotherapy) benefit from this form of treatment.

  Bone marrow transplantation and/or stem cell transplantation are the only treatment that has been relatively successful at causing the MDS to go into remission. There are numerous potential side effects associated with this form of treatment, and patients with advanced age or other medical problems may not be good candidates for a transplant.

Additional Risk Factors

• A study done at Columbia University Medical Center and New York Presbyterian Hospital suggests that the risks of developing secondary MDS following chemotherapy treatment may be heightened by certain other factors, including the use of GM-CSF or G-CSF in the treatment of breast cancer. This study, however, concluded that the rate of success when using chemotherapy in treating primary breast cancer outweighs the risk of MDS.