Myelodysplastic syndrome

Treatment

The main goal of treatment for myelodysplastic syndrome (MDS) is to improve the number of healthy blood cells circulating in your bloodstream. Treatment can vary greatly from person to person, so it’s important to come to a center, like Fred Hutchinson Cancer Center, that has specialized expertise.

Fred Hutch experts offer comprehensive treatment for all subtypes of myelodysplastic syndrome.

A diagnosis of MDS can feel overwhelming. We have an experienced, compassionate team ready to help.

MDS expertise at Fred Hutch

Everything you need is here

We have hematologists who specialize in MDS, the most advanced diagnostic and treatment programs and extensive support. Each year, we see about 200 patients with MDS or related diseases — including people whose disease was just found and many who began treatment elsewhere and then chose Fred Hutch for their ongoing care.

Hematologist A physician who specializes in diseases of the blood and blood-forming tissues.

Innovative MDS therapies

Fred Hutch patients have access to advanced therapies being explored in clinical studies for MDS conducted here and at UW Medicine.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease.

MDS treatment tailored to you

We view treatment as a collaborative effort. Your doctor will develop an individualized long-range management plan — considering everything medical science has to offer, as well as how and when different treatments should be used in your particular situation — and discuss all your options with you.

Team-based approach

Along with your hematologist, nurses and nurse case manager, we’ll involve additional experts who specialize in treating people with blood disorders and cancer if you need them — experts like a social worker, physical therapist, palliative care professional or dietitian.

Learn More About Supportive Care Services

Hematologist A physician who specializes in diseases of the blood and blood-forming tissues.

Ongoing care and support

Throughout treatment, your team provides follow-up care on a schedule tailored to you. During these visits, you’ll have an exam and may need tests to detect signs of disease. Follow-up visits are a good time to talk with your doctor about how to manage any side effects and how to enhance your well-being and quality of life.

Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose.

Personalized risk assessment

The Fred Hutch Hematologic Malignancy Genetics Clinic offers personalized risk assessment and follow-up care for adult patients and family members who may be at increased risk for developing blood-based malignancies due to an underlying genetic cause, including some people with MDS.

Treatment types

Treatment looks different for different people depending on your diagnosis. We tailor your treatment plan to you. Learn more about the treatment types offered at Fred Hutch.

Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Watchful waiting

This means you receive no treatment, but you visit your doctor on a regular basis (or if you notice changes) to check your health. Some people with MDS go for several years with no major health changes.

Watchful waiting

If your disease is mild and interferes only a little or not at all with your usual activities, your doctor may recommend watchful waiting.

Supportive care

You might receive:

The growth factor erythropoietin (EPO) to increase your red blood cells
The growth factor granulocyte colony-stimulating factor (G-CSF) or granulocyte macrophage colony-stimulating factor (GM-CSF) to increase your white blood cells
Medicines to manipulate your immune system
Medicines that may reduce your need for transfusions, such as lenalidomide (Revlimid) and antithymocyte globulin (ATG)
Antibiotics and antiviral medicines to fight infections that your white blood cells cannot fight on their own

Transfusions add red blood cells or platelets to your bloodstream if medicines do not increase your levels enough.

If you have more severe symptoms, your doctor is likely to recommend treatments aimed at controlling your underlying disease, such as:

Medicines to treat MDS
Chemotherapy like that given for acute myeloid leukemia
Bone marrow transplantation

Bone marrow The soft, spongy material in the center of your bones that produces all your blood cells, such as white blood cells, red blood cells and platelets. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Platelet A tiny, disc-shaped piece of a cell that is found in the blood and spleen. Platelets help form blood clots to slow or stop bleeding and to help wounds heal. A tiny, disc-shaped piece of a cell that is found in the blood and spleen. Platelets are pieces of very large cells in the bone marrow called megakaryocytes. They help form blood clots to slow or stop bleeding and to help wounds heal. Having too many or too few platelets, or having platelets that do not work as they should, can cause problems. Checking the number of platelets in the blood may help diagnose certain diseases or conditions. Red blood cell A type of blood cell that carries oxygen in the body. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.

Supportive care

If you have symptoms from your MDS, your doctor may recommend supportive care — steps to help reduce your symptoms. For MDS, supportive care may include medicines and transfusions.

Medicines to treat MDS

Lenalidomide (Revlimid) — to reduce the need for transfusions; given as a pill
Azacitidine (Vidaza) — to help increase red blood cells, white blood cells and platelets and reduce blasts (very immature abnormal cells); given as an injection or an infusion
Decitabine (Dacogen) — which may be toxic to abnormal MDS cells and promote growth of normal blood cells; given as an infusion

Many questions remain about how doctors can use azacitidine and decitabine most effectively. Clinical studies are going on to try to answer these questions.

Your Fred Hutch team will talk with you about the medicines we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and we’ll connect you with medical and support resources throughout Fred Hutch.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Infusion An injection of medications or fluids into a vein over a period of time. Platelet A tiny, disc-shaped piece of a cell that is found in the blood and spleen. Platelets help form blood clots to slow or stop bleeding and to help wounds heal. A tiny, disc-shaped piece of a cell that is found in the blood and spleen. Platelets are pieces of very large cells in the bone marrow called megakaryocytes. They help form blood clots to slow or stop bleeding and to help wounds heal. Having too many or too few platelets, or having platelets that do not work as they should, can cause problems. Checking the number of platelets in the blood may help diagnose certain diseases or conditions. Red blood cell A type of blood cell that carries oxygen in the body.

Medicines to treat MDS

Three medicines are used to treat MDS.

Leukemia-type chemotherapy

Doctors may use intensive anti-cancer medicines, or chemotherapy, like that used for acute myeloid leukemia, to kill myelodysplastic cells and control MDS.

You might receive chemotherapy through an intravenous (IV) line or by mouth. (Rarely, people with MDS receive chemotherapy directly into their spinal fluid to treat their central nervous system.) The medicines can help control your body’s production of abnormal blood cells. Chemotherapy for MDS can lower blood cell counts at first but may lead to remission (a period of no detectable disease activity).

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Remission A decrease in, or disappearance of, signs and symptoms of cancer. A decrease in, or disappearance of, signs and symptoms of cancer. In partial remission, some (but not all) signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body.

Leukemia-type chemotherapy

Doctors may use intensive anti-cancer medicines, or chemotherapy, like that used for acute myeloid leukemia, to kill myelodysplastic cells and control MDS.

Bone marrow transplant

If your MDS is severe or advanced, your team may recommend a bone marrow transplant (also called a hematopoietic cell transplant). This is currently the only type of treatment that has the potential to cure MDS.

In some groups of patients with MDS, the success rate (how many people are cured of their disease) is as high as 70 to 75 percent. Some of these patients have now been followed for 25 years or longer by their healthcare teams, with no sign that the disease has returned.

People having a transplant for MDS get stem cells from a donor (allogeneic transplant). The transplant works in two ways.

After you receive strong chemotherapy to eliminate the diseased cells in your marrow, the donor’s healthy stem cells restart your body’s ability to form blood cells.
White blood cells from the donor may recognize as foreign and attack any myelodysplastic cells that remain in your body.

A transplant is not right for everyone. For instance, it may be too challenging for older people, especially if they have other health problems along with MDS, as many older people do. Though some people have had successful transplants at age 70, a transplant is not the standard treatment in this age group.

That said, more people are eligible for allogeneic transplants than ever before, due to advances available at Fred Hutch, such as:

Non-myeloablative (reduced-intensity) transplants, which use lower-dose chemotherapy and are less toxic, generally with milder side effects
Transplants using stem cells from donated umbilical cord blood or haploidentical (half-matched) donors

Learn more about the Fred Hutch Bone Marrow Transplant Program, including the lifelong support you get through our Long-Term Follow-Up Program for transplant recipients.

Learn More About Bone Marrow Transplant

Bone marrow The soft, spongy material in the center of your bones that produces all your blood cells, such as white blood cells, red blood cells and platelets. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose. Standard care A treatment or other intervention currently being used and considered to be of proven effectiveness based on past studies. Stem cell A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells.

Bone marrow transplant

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