Supportive therapy for myelodysplastic syndrome

For many patients with myelodysplastic syndrome (MDS) the main goal of treatment is to prevent the problems caused by low blood cell counts. For example, low red blood cell counts (anemia) can cause severe fatigue. Patients with MDS and anemia often benefit from receiving red blood cell transfusions if erythropoietin isn’t helping them.

Some people are concerned about a slight risk of infection (hepatitis or HIV) spread by blood transfusion, but this possibility is very unlikely, and the benefits of the transfused cells greatly outweigh this risk.

Blood transfusions can cause excess iron to build up in the body. This extra iron can deposit in the liver and heart, causing the organs to function poorly. Iron build up is usually seen only in people who receive many transfusions over a period of years. Drugs called chelating agents (substances that bind with metal so that the body can get rid of it) can be used in patients who may develop iron overload from transfusions. The most commonly used drug is desferoxamine. This drug helps treat and prevent iron overload. This is given intravenously or as an injection under the skin. It is inconvenient because the injection must be given slowly (over several hours) 5 to 7 times per week. In some patients, treatment continues for years. Deferasirox (Exjade^®) is a newer drug that is taken by mouth once a day to treat iron overload. It has been used more for patients with certain congenital anemias (like thalassemia), but it can also help some MDS patients. This drug is not an option for patients with poor kidney function.

MDS patients with bleeding problems resulting from a shortage of platelets may benefit from platelet transfusions.

Patients with low white blood cell counts are very susceptible to infections. They should be especially cautious to avoid cuts and scrapes or to care for them without delay. They should tell their doctors immediately about any fever, signs of pneumonia (cough, shortness of breath), or urinary infection (burning when urinating). Doctors will treat known or suspected infections with antibiotics. For serious infections, a white blood cell growth factor may also be used. This drug can help raise the white blood cell count so that the body can fight the infection.