Myelodysplastic syndrome
Myeloid malignancy; Myelodysplastic syndrome; MDS; Preleukemia; Smoldering leukemia; Refractory anemia; Refractory cytopeniaMyelodysplastic syndrome is a group of disorders in which the blood cells produced in the bone marrow do not mature into healthy cells. This leaves you with fewer healthy blood cells in your body. The blood cells that have matured may not function properly.
Myelodysplastic syndrome (MDS) is a form of cancer. In about a third of people, MDS may develop into acute myeloid leukemia (AML).
Acute myeloid leukemia
Acute myeloid leukemia (AML) is cancer that starts inside bone marrow. This is the soft tissue in the center of bones that helps form all blood cell...
Read Article Now Book Mark ArticleCauses
Stem cells in bone marrow form different types of blood cells. With MDS, the DNA in stem cells becomes damaged. Because the DNA is damaged, the stem cells cannot produce healthy blood cells.
The exact cause of MDS is not known. For most cases, there is no known cause.
Risk factors for MDS include:
- Certain genetic disorders
- Exposure to environmental or industrial chemicals, fertilizers, pesticides, solvents, or heavy metals
- Smoking
Prior cancer treatment increases the risk for MDS. This is called secondary or treatment-related MDS.
- Certain chemotherapy medicines increase the chance of developing MDS. This is a major risk factor.
- Radiation therapy, when used with chemotherapy, increases the risk for MDS even more.
- People who have stem cell transplants may develop MDS because they also receive high doses of chemotherapy.
MDS usually occurs in adults age 60 years and older. It is more common in men.
Symptoms
Early stage MDS often has no symptoms. MDS is often discovered during other blood tests.
People with very low blood counts often experience symptoms. Symptoms depend on the type of blood cell affected, and they include:
- Weakness or tiredness due to anemia
- Shortness of breath
- Easy bruising and bleeding
- Small red or purple pinpoint dots under the skin caused by bleeding
- Frequent infections and fever
Exams and Tests
People with MDS have a shortage of blood cells. MDS may reduce the number of one or more of these:
- Red blood cells
- White blood cells
- Platelets
The shapes of these cells may also be changed. Your health care provider will perform a complete blood count and blood smear to find which type of blood cells have been affected.
Complete blood count
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...
Read Article Now Book Mark ArticleBlood smear
A blood smear is a blood test that gives information about the number and shape of blood cells. It is often done as part of or along with a complete...
Read Article Now Book Mark ArticleOther tests that may be performed are:
- Bone marrow aspiration and biopsy.
Bone marrow aspiration and biopsy
A bone marrow biopsy is the removal of marrow from inside one of your bones. Bone marrow is the soft tissue inside bones that helps form blood cells...
Read Article Now Book Mark Article - Cytochemistry, flow cytometry, immunocytochemistry, and immunophenotyping tests are used to identify and classify specific types of MDS.
- Cytogenetics and fluorescent in situ hybridization (FISH) are used for genetic analysis. Cytogenetic testing can detect translocations and other genetic abnormalities. FISH is used to identify specific changes within chromosomes. Genetic variations identified by next generation sequencing may help determine the response to treatment.
Some of these tests will help your provider determine what type of MDS you have. This will help your provider plan your treatment.
Your provider may define your MDS as high-risk, intermediate-risk, or low-risk on the basis of:
- The severity of shortage of blood cells in your body
- The types of changes in your DNA
- The number of immature white blood cells in your bone marrow
Since there is a risk of MDS developing into AML, regular follow-up with your provider may be required.
Treatment
Your treatment will depend on several factors:
- Whether you are low-risk or high-risk
- The type of MDS you have
- Your age, health, and other conditions you may have, such as diabetes or heart disease
The goal of MDS treatment is to prevent leukemia from developing and to prevent problems due to a shortage of blood cells, infections and bleeding. It may consist of:
- Blood transfusion
Blood transfusion
There are many reasons you may need a blood transfusion:After knee or hip replacement surgery, or other major surgery that results in blood lossAfter...
Read Article Now Book Mark Article - Medicines that promote the production of blood cells
- Medicines that suppress the immune system
- Low-dose chemotherapy to improve blood cell counts
Chemotherapy
The term chemotherapy is used to describe cancer-killing drugs. Chemotherapy may be used to:Cure the cancerShrink the cancerPrevent the cancer from ...
Read Article Now Book Mark Article - Stem cell transplantation
Stem cell transplantation
A bone marrow transplant is a procedure to replace damaged or diseased bone marrow with healthy bone marrow stem cells. Bone marrow is the soft, fatt...
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Your provider may try one or more treatments to see what your MDS responds to.
Outlook (Prognosis)
The outlook will depend on your type of MDS and severity of symptoms. Your overall health also may affect your chances of recovery. Many people have stable MDS that does not progress into cancer for years, if ever.
Some people with MDS may develop AML.
Possible Complications
MDS complications include:
- Bleeding
- Infections such as pneumonia, gastrointestinal infections, urinary infections
Pneumonia
Pneumonia is a lung infection. It can be caused by many different germs, including bacteria, viruses, and fungi. This article discusses pneumonia th...
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When to Contact a Medical Professional
Contact your provider if you:
- Feel weak and tired most of the time
- Bruise or bleed easily, have bleeding of the gums or frequent nosebleeds
- You notice red or purple spots of bleeding under the skin
References
National Cancer Institute website. Myelodysplastic/myeloproliferative neoplasms treatment (PDQ) - health professional version. www.cancer.gov/types/myeloproliferative/hp/mds-mpd-treatment-pdq. Updated January 26, 2022. Accessed March 19, 2024.
Nguyen PL, Hasserjian RP. Myelodysplastic syndromes. In: Hsi ED, ed. Hematopathology: Foundations of Diagnostic Pathology. 3rd ed. Philadelphia PA: Elsevier; 2018:chap 18.
Stone RM. Myelodysplastic syndromes. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 167.
Red blood cell production
Animation
Bone marrow aspiration - illustration
A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some storage diseases, in which abnormal metabolic products are stored in certain bone marrow cells.
Bone marrow aspiration
illustration
Bone marrow aspiration - illustration
A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some storage diseases, in which abnormal metabolic products are stored in certain bone marrow cells.
Bone marrow aspiration
illustration
Review Date: 12/31/2023
Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.