Chemotherapy uses medication to destroy rapidly dividing cancer cells in the bone marrow. Chemotherapy may be an option for some Myelodysplastic Syndrome Treatment patients if their disease is high risk or advanced. Common chemotherapy drugs used to treat MDS include:
– Azacitidine (Vidaza): This DNA methyltransferase inhibitor works to slow the growth of abnormal cells in the bone marrow. It is often the first-line treatment for higher-risk MDS and is taken by mouth or injection.
– Decitabine (Dacogen): Like azacitidine, decitabine is a DNA methyltransferase inhibitor. It works similarly to slow the growth of abnormal cells. It is also often the initial treatment for higher-risk MDS and can be given by mouth or injection.
– Cytarabine (Cytosar): This chemotherapy drug works to stop cancer cell growth by interfering with DNA synthesis. It may be used to treat MDS alone or in combination with other medications. Treatment is by IV infusion.
– Idarubicin (Idamycin PFS): An anthracycline chemotherapy, idarubicin works by interfering with DNA replication. It is sometimes combined with cytarabine for higher-risk MDS treatment. Given intravenously.
Stem Cell Transplantation
A stem cell transplant, also called a bone marrow transplant, replaces damaged or diseased bone marrow with healthy bone marrow stem cells. This treatment is currently only considered curative for MDS. There are two main types of stem cell transplants used for MDS:
– Allogeneic transplant: In this type, stem cells are obtained from a matched related or unrelated donor. The patient undergoes chemotherapy and/or radiation therapy before the transplant to eliminate the original marrow. The new donor stem cells are then infused through an IV.
– Autologous transplant: Here, the patient's own stem cells are used after being collected prior to treatment and then stored. These “backup” stem cells are infused back into the patient after high-dose chemotherapy and/or radiation to treat the MDS.
Growth Factors
Growth factors are naturally occurring proteins that stimulate blood cell production. Some growth factors may be used to treat specific MDS related complications:
– Erythropoietin (Epogen, Procrit): This growth factor stimulates red blood cell production and can help reduce need for red blood cell transfusions in some MDS cases. Given by injection under the skin or IV.
– G-CSF (Neupogen, Zarxio, Filgrastim): Granulocyte colony-stimulating factor boosts white blood cell counts after chemotherapy to help prevent or treat infections. Given by daily injection.
– Thrombopoietin Receptor Agonists: Drugs like eltrombopag (Promacta) and romiplostim (Nplate) stimulate platelet production and reduce need for platelet transfusions in some MDS patients. Taken orally or by injection.
Supportive Myelodysplastic Syndrome Treatments
Certain measures may help manage MDS symptoms and complications as the disease progresses including:
– Blood transfusions: Red blood cell and platelet transfusions can address anemia and low platelet counts, respectively, from the disease.
– Antibiotics: When white blood cell counts drop, antibiotics help prevent and treat infections that MDS patients are at higher risk for.
– Medications: Iron supplements may help build red blood cells, while drugs are also used to treat bone pain or itching that may occur in some MDS patients.
– Growth factor support: Beyond the growth factors already mentioned, filgrastim and sargramostim injections may boost overall blood cell counts in some cases.
– Surgery: A splenectomy to remove an enlarged spleen can sometimes improve blood counts in certain MDS subtypes where the spleen destroys blood cells prematurely.
Considerations for Myelodysplastic Syndrome Treatment
Treatment selection depends on various factors including the MDS subtype and risk level, overall patient health and preferences, and transplant eligibility. Treatment goals may include:
– Slowing disease progression or improving blood counts
– Reducing symptoms and complications
– Increasing survival time
– Possibly curing the disease through transplant if a matched donor is available
Close monitoring by a hematologist/oncologist helps guide treatment approaches and changes as the disease progresses or responds over time. A multidisciplinary care team offers the full range of options to maximize quality of life and outcomes.
