Chemotherapy for myelodysplastic syndrome

Chemotherapy (chemo) is the use of drugs, taken by mouth or put into a vein, to treat cancer. The drugs enter the bloodstream and reach most places in the body. The purpose of the chemo is to kill the abnormal stem cells and allow normal ones to grow back.

Because MDS can progress to acute leukemia, patients with MDS may get the same treatment as leukemia patients. This type of treatment can help some patients, but it has many severe side effects. Problems from this kind of chemo may hasten death, particularly in the elderly. Still, this treatment may be an option for some patients with advanced MDS.

Another option is to use lower doses of chemo drugs. This approach can lower the chance of serious side effects.

While chemo drugs kill cancer cells, they can also damage normal cells, causing side effects. These side effects depend on the type of drugs given, the dose, and how long they are given.

Short-term side effects can include:

• Hair loss (the hair grows back once treatment ends)
• Mouth sores
• Loss of appetite
• Nausea
• Vomiting
• Greater chance of infection (from a shortage of white blood cells)
• Easy bruising and bleeding (from low platelet counts)
• Tiredness, called fatigue (from a shortage of red blood cells)

The doctor will watch carefully for all side effects and adjust treatment as needed. Your health care team often can suggest ways to lessen side effects. For example, other drugs can be given along with the chemo to prevent or reduce nausea and vomiting.

If a patient’s white blood cell counts are very low during treatment, the risk of infection can be reduced by doing certain things. Patients should be very careful about washing their hands and not eating fresh, uncooked fruit and other foods that might carry germs. They might also wear a surgical mask around crowds. The doctor might also give strong antibiotics even before an infection has started.

If platelet counts are low, patients might have platelet transfusions or red blood cell transfusions if their red cell counts are low. They might receive growth factors to raise red blood cell counts.

Hypomethylating agents

These drugs are a form of chemo that affects the way genes are controlled. They help in MDS by slowing down genes that promote cell growth. They also kill cells that are dividing rapidly. In some MDS patients, these drugs improve blood counts, lower the chance of getting leukemia, and even prolong life. Red blood cell counts may improve enough to stop transfusions.

These drugs have some of the same side effects as regular chemotherapy, but these side effects are usually mild. They include:

• Nausea/vomiting
• Diarrhea or constipation
• Fatigue and weakness
• Low blood counts (most often the white blood cells or platelets)