Myelodysplastic syndrome (MDS) (also called myelodysplasia) is a group of conditions where the bone marrow does not work properly and makes faulty blood cells.
These abnormal cells are called dysplastic cells. Dysplastic cells do not work and are quickly destroyed by the body. This means there are not enough blood cells in the blood. It is a rare type of blood cancer, which affects the bone marrow.
Bone marrow is a spongy tissue found inside the bones, where blood cells are made.
In the early stages, myelodysplastic syndrome may not cause any symptoms.
In some cases, MDS is found during a routine blood test carried out for another reason, meaning some people are diagnosed before they experience any symptoms or complications related to the condition.
If you do have symptoms, they vary from person to person, depending on which blood cells are affected. The main symptoms of MDS are caused by low levels of healthy blood cells and they can include:
- fatigue - feeling tired or weak
- shortness of breath
- bleeding more than usual (such as having frequent nosebleeds, bleeding gums or heavier periods)
- bruising more than usual
- unusual paleness
- frequent infections or taking longer than usual to recover from illnesses
- a rash that looks like small bruises or bleeding beneath the skin and does not fade when you roll a glass over it
There are several different types of MDS. The type you are diagnosed with depends on a few key factors:
- the type of blood cells that are abnormal - red blood cells, white blood cells, platelets, or a combination
- the number of immature blood cells (called blasts) present in the blood or bone marrow
- whether there are genetic changes in the blood cells, such as a change called isolated del(5q)
The main types of myelodysplastic syndrome include:
- Myelodysplastic syndromes with single-lineage dysplasia (MDS-SLD), where only one type of blood cell (red cells, white cells, or platelets) is low in number and appears abnormal under the microscope.
- Myelodysplastic syndromes with multilineage dysplasia (MDS-MLD), where two or three blood cell types are abnormal.
- Myelodysplastic syndromes with ring sideroblasts (MDS-RS), where one or more blood cell types are low. A key feature is that some red blood cells in the bone marrow contain excess iron arranged in a ring pattern.
- Myelodysplastic syndromes with isolated del(5q), where red blood cell levels are low and a specific genetic change affects chromosome 5.
- Myelodysplastic syndromes with excess blasts (MDS-EB), where any of the three types of blood cells (red cells, white cells, or platelets) may be low and appear abnormal. Higher numbers of very immature cells (blasts) are found in the blood and bone marrow.
- Myelodysplastic syndromes, unclassifiable (MDS-U), where one or more types of mature blood cells are reduced and may look abnormal. In some cases, the blood cells appear normal, but analysis may reveal DNA changes associated with myelodysplastic syndromes.
Treatment for myelodysplastic syndromes at CUH
Myelodysplastic syndrome often develops very slowly, over several years, therefore you may not need treatment straight away.
The treatment you have depends on several factors, which include:
- the type of MDS you have
- your symptoms
- how quickly your symptoms are expected to worsen, and the risk of MDS developing into acute myeloid leukaemia
- your age and general health
A team of specialists at CUH will meet to discuss your condition and to make a recommendation about the best possible treatment for you.
You, along with your clinician, will then discuss your treatment recommendations at the clinic appointment and decide on the right treatment plan for you. Your clinician will explain different treatment options and possible side effects.
If you have low-risk MDS and few symptoms, you will usually have regular check-ups, including blood tests. You may however, need treatment in the future if your condition gets worse.
If you have higher-risk MDS, treatment may include:
- chemotherapy
- bone marrow (stem cell) transplant
- immunosuppressants
- targeted therapy
- immunotherapy
At times, you may require more than one treatment or a combination of different treatments to control the disease and its symptoms and help you live longer.
Management of myelodysplastic syndromes is most often intended to slow the disease, ease symptoms and prevent complications. Common measures include blood transfusions and medications to boost blood cell production. In certain situations, a bone marrow transplant may be recommended to replace your bone marrow with healthy bone marrow from a donor.
MDS cannot usually be cured, but the symptoms can often be managed with treatment. Your clinical team will discuss with you what to expect and will help you control the cancer and manage your symptoms.