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 Seattle Cancer Care Alliance (SCCA), that has specialized expertise.

SCCA 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 SCCA

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 SCCA for their ongoing care.

Innovative MDS therapies

SCCA patients have access to advanced therapies being explored in clinical studies for MDS conducted here and at our founding organizations Fred Hutchinson Cancer Research Center and UW Medicine.

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

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. 

Personalized risk assessment

The SCCA 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 SCCA. 

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
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 SCCA 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 SCCA.

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). 

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.

  1. 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.
  2. 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 SCCA, 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 at SCCA, including the lifelong support you get through our Long-Term Follow-Up Program for transplant recipients.

Learn More About Bone Marrow Transplant

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.