Myelodysplastic Syndromes

Myelodysplastic Syndromes: Treatment, Causes, Types & Doctors in India

Myelodysplastic Syndromes or MDS is a blood disorder that causes a drop in the number of healthy blood cells. It is sometimes also referred to as a Bone Marrow Failure Disorder.

The Bone Marrow is a soft, gelatinous tissue found in bones and is responsible for producing Red Blood Cells (that carry oxygen around the body), White Blood Cells (that help fight infection), and, Platelets (that help the blood to clot).

In MDS, the bone marrow doesn’t make enough of these three types of blood cells. Instead, it makes undeveloped and abnormal cells that don’t function properly. And, gradually the bone marrow becomes full of these abnormal blood cells, eventually spilling out into the bloodstream.

Different Types of MDS

Depending on the type of blood cells affected, there are three main types of MDS: 

  • Refractory Anemia – just the red blood cells are affected
  • Refractory Cytopenia – red blood cells, white blood cells, and platelets are affected
  • Refractory Anemia with Excess Blasts (RAEB) – red blood cells, white blood cells, and platelets are affected, and there is a higher risk of developing Acute Leukaemia

Symptoms of MDS

The symptoms of MDS are generally mild in the beginning, but gradually they get worse. The initial symptoms are

  • Weakness, tiredness and occasional breathlessness – this is because of the low number of red blood cells.
  • Frequent infections – this is because of the low number of white blood cells.
  • Bruising & easy bleeding (such as nosebleeds) – this is because of the low number of platelets

Some types of MDS develop more quickly than others. Some people with MDS don’t have any symptoms, and their condition is picked up after they have blood tests for something else. 

Largely, the symptoms of MDS depend on the type of MDS – for example, some people just have a problem with their red blood cells and have the symptoms of anemia. 

Causes of MDS

MDS can affect people of any age, but it is most common in people aged 65-70 years – only one in five people with MDS are younger than 50. In most cases, the cause of MDS is unknown, however, exposure to the chemical benzene (used in the rubber industry, and found in petrol) is known to increase the risk of developing MDS. In some rare cases, MDS is caused by radiotherapy or chemotherapy treatment for cancer.

How is MDS Diagnosed?

To confirm whether a patient has MDS, the doctor will initially enquire about the symptoms and the history of other health problems, and then: 

  • Do a physical exam to check for other possible reasons for the symptoms
  • Take a sample of blood to count the different types of cell
  • Get a sample of the bone marrow for analysis, and
  • Order a genetic analysis of cells from the bone marrow

How is MDS Treated?

The treatment of MDS largely depends on the type of MDS and its severity. The doctor will refer the case to a Haematologist or a Haemato-Oncologist who may opt for any of the two forms of treatment: 

  • A Low-Intensity Treatment
  • A High-Intensity Treatment

The aim of the treatment is to get the number and type of blood cells in the bloodstream back to normal and manage symptoms with supportive treatment. 

A Low-Intensity Treatment may include the following: 

  • Chemotherapy – taking drugs, either taken as a tablet or an injection, that destroy the immature blood cells by disrupting their growth. 
  • Immunosuppressive Therapy – this tries to stop the immune system from attacking the bone marrow.

If the symptoms persist, the Haematologist/ Haemato-Oncologist may opt for a High-Intensity Treatment that includes: 

  • A Stem Cell Transplant – this is the only treatment that can cure MDS.
  • A combination of several types of chemotherapies that might include the use of a chemotherapy drug called Azacitidine. 

Supportive treatments to manage the symptoms include: 

  • Blood Transfusions – drip may contain red blood cells or white blood cells or platelets, depending on which cells have been affected.
  • Iron Chelation – drugs to get rid of the excess iron in the blood.
  • Man-made growth factor hormones – hormones that encourage the bone marrow to make healthy blood cells.

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Dr. Vikas Dua

Head and Senior Consultant, Pediatric Hematology Oncology, and Bone Marrow Transplant

Dr. Vikas Dua is Paediatric Hemato Oncologist and bone marrow transplant specialist of the generation. Dr. Dua's results in the field of Paediatric Haematology Oncology and BMT have been some of the best. He and his team has done 200 + paediatric transplants. 

About Dr. Rahul Bhargava

Hematologist, Hemato-oncologist & Stem Cell Transplant Physician

With over 20 years of experience, Dr. Rahul Bhargava is currently the Director of Haematology, Paediatric Haematology, Immunology and Stem Cell Transplant at Fortis Memorial Research Institute (FMRI), Gurgaon – India’s first integrated Centre of Excellence in Haematology, Paediatric Haematology, and Stem Cell Transplant.

Dr. Aniruddha Dayama

Hematology, Pediatric Oncology & Bone Marrow Transplant Specialist

Dr. Aniruddha Dayama in 2015 led the efforts to get NMDP, USA approval for one of the leading hospitals in Gurgaon. He and his team have popularised autologous transplants in multiple sclerosis. The team has been credited for establishing six low-cost centers across North India.