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Myelodysplastic Syndrome

Overview :

Blood cells are used in the body for many different and important functions, such as carrying oxygen (red blood cells), fighting infection (white blood cells), and controlling bleeding (platelets). Blood cells are formed and stored in the bone marrow, which is the spongy tissue inside large bones. Stem cells, or immature blood cells, are stored in the bone marrow and have the ability to develop into all three types of mature blood cells. When the body needs a specific type of blood cell, the bone marrow uses its stockpile of stem cells to produce the kind of mature cells needed for that particular situation.

In patients who have MDS, blood cells fail to mature normally. In other words, the bone marrow is unable to develop a normal amount of mature blood cells, and is also not able to increase blood cell production when mature cells are needed. Sometimes, even the cells that are produced do not function normally. The marrow eventually becomes filled with the immature cells and there is not room for the normal cells to grow and develop. MDS therefore causes a shortage of functional blood cells.

Subtypes of MDS

MDS is divided into five different subtypes that are classified according to the number and appearance of blast cells in the bone marrow. It is important for doctors to know the type of MDS a patient has, because each subtype affects patients differently and requires specific treatment. The International Prognostic Scoring System (IPSS) can help the doctor to determine the best treatment for an individual patient. The subtypes are as follows:

  • Refractory anemia (RA). Bone marrow with less than 5% blast cells and abnormal red blood cell blasts
  • Refractory anemia with ring sideroblasts (RARS). Bone marrow with less than 5% blasts and characteristic abnormalities in red blood cells
  • Refractory anemia with excess blasts (RAEB). Bone marrow with 5-20% blast cells, and higher risk of changing into acute leukemia over time
  • Refractory anemia with excess blasts in transformation (RAEBT). Bone marrow with 21-30% blast cells. This form is most likely to change into acute leukemia.
  • Chronic myelomonocytic leukemia (CMMoL). Marrow with 5-20% blasts and excess monocytes (a specific type of white blood cell).

Approximately 15,000 new cases are diagnosed annually in the United States. The average age at diagnosis is 70. The most common types are RA and RARS. It is rare to have MDS before age 50. MDS is slightly more common in males than in females.

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