MDS Management Therapies

Currently, supportive care is the primary approach for managing myelodysplastic syndromes (MDS), and it is accomplished by actively monitoring symptoms and treating them with transfusion, antibiotics and other therapies.

Doctors typically prefer to use erythropoietin (EPO) to manage the anemia that is common to many MDS subtypes. For patients who do not respond to EPO alone, doctors may combine EPO with other growth factors, such as granulocyte colony-stimulating factor (G-CSF) or granulocyte macrophage colony-stimulating factor (GM-CSF).1,3

For patients who do not respond to, or are not good candidates for, EPO, the primary management therapy for anemia is red blood cell transfusion. Transfusion often is leukocyte reduced1 and is recommended when the patient’s hematocrit remains below 25% for long periods.2 Although transfusion can provide immediate symptom improvement, it requires additional monitoring due to its common side effects.1

The transfusion side effect of most concern is the buildup of iron that can result from the accumulation of red blood cells. Consequently, the transfused patient’s serum ferritin levels and organ health must be closely monitored. Excess iron is removed through chelation by subcutaneous administration of desferrioxamine. This prevents the potential damage to organs and other tissues caused by iron overload.1

Another potential side effect of transfusion is fluid retention. This is most problematic in older patients and can cause shortness of breath and discomfort. This condition should be monitored and may be treated with diuretics.2 To minimize the need for red blood cell transfusion, EPO typically is administered daily or three times a week.1,3

Transfusion is not used to manage neutropenia.2 Rather, G-CSF or GM-CSF is used to increase neutrophil production, and the patient’s infection status is closely monitored. Patients are encouraged to respond rapidly to fevers, and infections are treated with antibiotics.3

Thrombocytopenia rarely is managed with platelet transfusion due to the risk of patients becoming resistant to transfused platelets and requiring new platelet transfusion. Platelet transfusion generally is considered only when the platelet count drops below 10,000 platelets/mL of blood. Management therapies that increase platelet counts may be on the horizon; ongoing studies of certain growth factors, particularly thrombopoietin, are revealing promising results.2

Besides managing the symptoms of MDS, helping patients improve their overall wellness, including their emotional well-being, is essential to helping them manage their disease.3 Visit the Wellness Strategies page for more information.