Supportive Therapy for Myelodysplastic Syndromes (MDS)

Supportive therapies help treat (or prevent) the symptoms or complications of myelodysplastic syndromes (MDS), as opposed to treating the MDS directly. Supportive therapy might be used alone, especially for people with lower-risk MDS, or it might be used along with other treatments.

The main goal of this type of treatment is to improve a person’s comfort and quality of life, regardless of how advanced the MDS might be. You might also hear supportive care referred to as palliative care, symptom management, or comfort care.

For example, shortages of blood cells (red blood cells, platelets, or white blood cells) cause most of the symptoms and complications in people MDS, so one of the main goals is to prevent or treat the problems caused by low blood cell counts.

Treating low red blood cell counts (anemia)

Having too few red blood cells (anemia) is the most common type of blood cell shortage in people with MDS. Anemia can cause severe fatigue and other symptoms.

Red blood cell transfusions

People with MDS and anemia that’s causing symptoms might be helped by red blood cell transfusions. While some people might be concerned about getting an infection (such as hepatitis or HIV) from a blood transfusion, this risk is extremely low, and the benefits of getting the transfused cells greatly outweigh this risk.

Treating iron build up from blood transfusions

One problem with getting a lot of blood transfusions over time is that it can cause excess iron to build up in the liver, heart, and other organs, affecting how they function. This usually is seen only in people who get many transfusions over a period of years. People at risk for iron overload are often advised to avoid taking iron supplements or multivitamins that contain iron.

Drugs called chelating agents, which bind with the iron so that the body can get rid of it, can be given to people who develop iron overload from red blood cell transfusions (unless they have poor kidney function). These include:

• Deferoxamine (Desferal) usually is given as an infusion under the skin, using a small, portable pump. This must be done slowly (over at least 8 hours) each day or on most days of the week. 
• Deferasirox (Exjade, Jadenu) is a newer drug that is taken by mouth (as a tablet, dissolved in juice or water, or sprinkled on food) once a day. 

To learn more about red blood cell transfusions, see Blood Product Transfusions.

Red blood cell growth factors and other medicines

Growth factors are hormone-like substances that help bone marrow make new blood cells. These substances occur naturally in the body, but they can also be manmade in large amounts.

Growth factors are given usually by subcutaneous (under the skin) injection. Your health care team can give the injections, or you or your family members might be able to learn to give them at home.

• Epoetin alfa (Epogen and other brand names) is a manmade version of the growth factor erythropoietin, which helps the bone marrow make new red blood cells. It can help lower the number of red blood cell transfusions some people need.
• Darbepoetin alfa (Aranesp) is a long-acting form of epoetin. It works in the same way but can be given less often.

Other medicines that raise red blood cell counts in different ways might also be helpful for some people.

• Luspatercept (Reblozyl) is a red blood cell maturation agent. This drug affects TGF-β proteins in the bone marrow, which normally help control how quickly new cells in the bone marrow mature into functioning red blood cells. By acting on specific TGF-β proteins, luspatercept helps the bone marrow make more mature red blood cells. This drug is injected under the skin, typically once every 3 weeks.
• Imetelstat (Rytelo) is a telomerase inhibitor. It can be used to help raise red blood cell counts in people with MDS whose anemia isn’t being helped by the growth factors above. Imetelstat is given as an infusion into a vein (IV), typically once every 4 weeks.
• Lenalidomide (Revlimid) is an immunomodulating drug (IMiD). It can often lower the need for blood transfusions in people with MDS, especially if the MDS cells are missing a part of chromosome 5 (del[5q]). To learn more about this drug, see Medicines to Treat Myelodysplastic Syndromes.

Treating low platelet counts

People with MDS who have low platelet counts might bleed or bruise easily.

Platelet transfusions

For people with very low platelet counts, transfusions of platelets collected from donors might be needed to raise platelet levels. This is especially true for people who have signs of bleeding as a result of a low platelet count.

For more information about platelet transfusions, see Blood Product Transfusions.

Platelet growth factors and other medicines

For people who aren’t helped by platelet transfusions, some types of medicines might be used:.

• One option might be treatment with an antifibrinolytic agent, such as aminocaproic acid (Amicar).
• Drugs called thrombopoietin receptor agonists (TPO-RAs), such as romiplostim (Nplate) and eltrombopag (Promacta), might help raise platelet counts in some people with very low platelet levels.

Treating low white blood cell counts

People with MDS who have low white blood cell counts (especially neutropenia) are more likely to get infections, and the infections are more likely to be serious.

It's important to avoid cuts and scrapes, and to take care of them right away if they do happen. People with low white blood cell counts should tell their doctors right away about any possible signs of infection, such as fever or signs of pneumonia (cough, shortness of breath) or a urinary tract infection (burning when urinating).

White blood cell growth factors

As noted above, growth factors are hormone-like substances that can help the bone marrow make more new blood cells. Manmade versions of some growth factors can be given (often as injections under the skin) to help raise white blood cell counts.

Granulocyte colony-stimulating factor (G-CSF, filgrastim, Neupogen, other brand names) can help the body make more white blood cells. This medicine isn’t used routinely to prevent infections, but it can help some people with MDS whose main problem is a shortage of white blood cells and who have frequent infections.

Pegfilgrastim (Neulasta, other brand names) is a long-acting form of G-CSF. It works in the same way but can be given less often.

Antibiotics and vaccines

Typically, known or suspected bacterial infections are treated with antibiotics. But usually, antibiotics aren’t given to help prevent infections in people with low white blood cell counts.

Because people with MDS are often at higher risk of infections, it’s important to stay up to date with vaccines to help prevent them. To learn more, see Vaccinations and Flu Shots for People with Cancer.

For more information about infections and how to lower your risk, see Infections in People With Cancer.