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Myelodysplastic Syndromes

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Information about Treatment:

  • Blood Transfusion
     
  • Understanding Drug Therapy & Managing Side Effects
     
  • Blood and Marrow Stem Cell Transplantation

    • Understanding Myelodysplastic Syndromes
    Incidence
    Causes and Risk Factors
    Signs and Symptoms
    Diagnosis
    International Prognostic Scoring System
    Subtypes
    Treatment
    Research and Clinical Trials
    Childhood MDS
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    Understanding Myelodysplastic Syndromes

    Myelodysplastic syndromes (MDS) is a term that is used to describe a group of cancers of the blood and marrow. There are several types of MDS. 

    Improved outcomes and quality of life for MDS patients are the result of

    • Better supportive care
    • Treatment with newer agents (lenalidomide, azacitidine and decitabine)
    • Progress in stem cell transplantation
    • Studies of new drugs in clinical trials.

    MDS begins in the bone marrow with a change (mutation) to a normal stem cell. Some types of MDS—called "low-risk MDS"

    • Progress slowly 
    • Mainly cause mild to moderate anemia.

    In low-risk MDS, the red cells, white cells and platelets made in the marrow continue to enter the blood and function normally:

    • Red cells carry oxygen to the cells in the body.
    • Neutrophils and monocytes are able to kill bacteria that invade the body.
    • The platelets can plug up injuries to blood vessels.

    Other types of MDS—called "high-risk MDS"—may cause severe problems. In people with high-risk MDS, immature cells called "blast cells" often make up more than 5 percent of the cells in the marrow. (Normally, blast cells make up less than 5 percent of all cells in the marrow.) 

    • The blast cells that are made do not develop into normal red cells, white cells and platelets.
    • There are sharp decreases in blood cell counts (red cells, white cells and platelets).
    • The low blood counts can lead to:

    Anemia

    Low red cell count

    Neutropenia

    Low neutrophil count

    Thrombocytopenia

    Low platelet count

     

    People with more than 20 percent blast cells in the marrow cells are considered to have acute myelogenous leukemia (AML). For more information about AML, see the free LLS booklet Acute Myelogenous Leukemia.

    MDS is sometimes called "smoldering leukemia," or "preleukemia." These names may be misleading. Many patients ask whether MDS is "cancer." MDS is a diagnosis of cancer. The term "cancer" means that a change to a normal cell leads to the development of abnormal cells. However, it is important to know that how a disease affects a person's life matters more than a term used to describe the disease. Low-risk MDS can interfere less with quality of life than other diseases that are not considered cancer, such as heart disease or emphysema. High-risk MDS can be as serious or life-threatening as AML.

    It is important to get an accurate diagnosis and to get the proper treatment for the type of MDS that a person has.

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    Incidence

    It is estimated that there will be more than 11,000 new cases of MDS diagnosed in the United States in 2008. The overall incidence rate is estimated at close to four cases per 100,000 population. According to SEER's 2001-2005 data, MDS most commonly strikes males ages 70 and above.

    For the five-year period 2001-2005, there were approximately 50,484 cases of MDS throughout the United States, averaging 10,097 cases per year (a total of 27,629 in males, averaging 5,526 per year; and a total of 22,856 in females, averaging 4,571 per year). This results in an incidence rate of 3.8 cases per 100,000 population for both genders - 5.1/100,000 population in males, and a much lower 2.9/100,000 population in females.

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    Causes and Risk Factors

    MDS may be

    • Primary (also called "de novo")
    • Secondary

    The vast majority of patients with MDS have primary MDS. This type usually has no clear-cut cause.

    Secondary MDS may occur following

    Benzene damages the DNA of normal stem cells. Cigarette smoke is now the leading known source of exposure to this toxin. Benzene is also found in certain industrial settings. However, strict regulation in the United States and other countries now limits benzene exposure in the workplace.

    Most people who are exposed to chemotherapy, radiation therapy and/or benzene do not develop MDS. People who do develop secondary MDS may have inherited genes that limit their ability to detoxify the causative agents. 

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    Signs and Symptoms

    Symptoms of MDS may include 

    • Fatigue
    • Shortness of breath during physical activity

    These symptoms are common to many other diseases.

    Some patients have no symptoms. MDS may be diagnosed as a result of a routine physical examination and a blood test called a complete blood cell count (CBC).

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    Diagnosis

    A diagnosis is made by

    • Measuring a person's blood cell counts
    • Examining the blood and marrow cells under a microscope.

    A CBC is done to check red cell, white cell (neutrophil) and platelet counts.

    If the red cell count is low (anemia)

    • The cells are examined to find out if the anemia is caused by MDS or caused by: 
      - Low iron, folate, or vitamin B12 in the blood. 
      - Other types of cancer. 
      - Conditions that lead to rapid break down of red cells.

    The doctor will examine a sample of bone marrow if blood tests do not show one of these other causes of anemia. The tests used to examine the bone marrow cells are called bone marrow aspiration and bone marrow biopsy.

    A diagnosis of MDS is based on the presence of at least one of the following:

    • Blast cells = more than 5 percent of the marrow cells.
    • Cytogenetic abnormalities. "Cytogenetic" refers to chromosomes. MDS cells often have cytogenetic abnormalities. These are called "simple" when there are fewer than 3 changes. The changes are called "complex" when there are 3 or more changes.
    • Changes to the structure or form of the marrow (dysplasia).

    Making a diagnosis can be difficult. It is important to have the person's marrow sample (slides) examined by a hematopathologist—and sometimes a second hematopathologist—when there are

    • Only mild changes to the marrow
    • No more than 5 percent blasts
    • No cytogenetic changes.

    Common MDS Cytogenetic Changes

     

    A deletion (loss) of the q-arm of one of more of these chromosomes:

    • 5 (del 5q or 5q-)
    • 7 (del 7q or 7q-)
    • 20 (del 20q or 20q-)

    A complete deletion of chromosome 5 (-5) or chromosome 7 (-7)

    Trisomy 8 (an extra copy of chromosome 8, so that there are 3 copies instead of the normal pair of chromosomes.

    Another test, fluorescent in situ hybridization (FISH) may be used to identify certain types of  MDS and to follow the effects of therapy.

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    International Prognostic Scoring System

    The International Prognostic Scoring System (IPSS) is used by many doctors to assess the severity of a patient's MDS. The IPSS uses 3 indicators to predict the course of the patient's disease:

    • The percentage of blast cells in the marrow
    • The presence and severity of chromosome changes in the blast cells
    • The presence of one or more low blood cell counts (cytopenias).

    These indicators are sometimes called "prognostic indicators."  Each of the indicators is given a numeric score (see Table 1).

     Table 1.  International Prognostic Scoring System (IPSS)

    Factor

    Notes

    Value

    IPSS Score

    Blasts

     

    5% or less

    0

     

    5% to 10%

     

    0.5

    11% to 20%

     

    1.5

    21% to 30%

     

    2.0

    Cytogenetics

    Normal; -Y only; 5q- only; or 20q- only

     

    = Good

     

     

    0

    Abnormalities other than good or poor

     

    = Intermediate

     

    0.5

    Complex; 3 or more abnormalities or abnormal chromosome 7

     

    = Poor

     

     

    1.0

    Cytopenias

    Hemoglobin <10 g/dL; absolute neutrophil count (ANC) <1,500/mL;

    platelet count <100,000/mL; each count as a value of 1.

     

     

    0/1

     

    0

     

     

    2/3

     

    0.5

    The numeric scores for the blast percent, the cytogenetic changes and the cytopenias are combined to give the total numeric score. The scores equal a risk category:

    • Low
    • Intermediate-1
    • Intermediate-2
    • High

    The risk-categories are sometimes combined as

    • Low and intermediate-1 =  low-risk MDS
    • Intermediate-2 and high =  high-risk MDS

     

    Total Score

    IPSS Risk Category

    Example

    0 =

    low

    A total score of 0 (low-risk)

    ·        Marrow blasts less than or = to 5 percent

    ·        No cytogenetic abnormalities

    ·        Hemoglobin of less than 10 grams per deciliter (<10 g/dL) with normal platelet counts and normal neutrophil counts

    A total score of 2.0 (intermediate-2)

    ·          5 to 10 percent blasts

    ·          A deletion of chromosome 7

    ·          Anemia and a platelet count of less than 50,000 per microliter (μL)

    0.5-1.0 =

    intermediate-1

    1.5-2.0 =

    intermediate-2

     

    ≥ 2.5 =

    high

     

     

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    Subtypes

    MDS has also been classified into different subtypes by the French-American-British (FAB) Work Group and by the World Health Organization (WHO). Some doctors use the FAB classification or the WHO classification of MDS with the IPSS.

     

    MDS Subtypes—French-American-British (FAB) Work Group

    Subtype

    Comments

    Refractory anemia (RA)

     

    Main effects are low red cells (anemia) and mild to moderate decreases in white cells and platelets. RA is also referred to as "myelodysplasia."

    Refractory anemia with ringed sideroblasts (RARS)

     

    RA with an abnormal accumulation of iron granules in developing cells called "sideroblasts." This disorder is also referred to as "acquired sideroblastic anemia."

    Refractory anemia with excess blasts (RAEB)

     

    RA with clear signs of abnormal blast cells.

    Refractory anemia with excess blasts in transformation

    (RAEB-T)

    Bone marrow blast count ranges from 20 to 30 percent.

    Chronic myelomonocytic leukemia (CMML)

    Red cells, white cells and platelets may be affected, but also increased monocyte count (a type of white cell) with a small number of abnormal blast cells in the marrow.

     

     

    Main Differences Between WHO and FAB Systems

     

    The WHO system

     

    • Makes use of cytogenetic findings
    • Defines RAEB-T (more than 20 percent blast cells) as AML
    • Adds a new category—myelodysplastic syndromes/myeloproliferative disorders (MDS/MPD—with juvenile myelomonocytic leukemia [JMML] and chronic myelomonocytic leukemia [CMML])
    • Adds the subtypes 5q- syndrome, refractory cytopenia with multilineage dysplasia (RCMD) and unclassifiable MDS (MDS-u).

     

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    Treatment

    MDS patients are usually treated by a hematologist—a doctor who specializes in treating blood disorders and blood cancers, including MDS. Patients are advised to discuss individual risk and treatment options with their doctors. Patients—especially those with high-risk MDS—may want to discuss treatment in a clinical trial.

    At present, the one potential cure for MDS—high-dose chemotherapy with allogeneic stem cell transplantation (allotransplantation)—is only a practical option for younger patients with

    • High-risk MDS
    • A matched stem cell donor 
    • A life expectancy without successful treatment that merits the risk of undergoing the transplant.

    Many patients with MDS have a life expectancy considered good enough that it would not make sense to undergo allotransplantation. For a patient with low-risk MDS, the benefits of this treatment generally do not outweigh the risks.

    In general, the goal of treatment for patients with lower-risk MDS is to

    • Manage the disease by reducing blood transfusion needs
    • Decrease the risk of infection
    • Increase the number of good quality years of life.

    There are several general approaches to treatment for MDS. These may be used alone or in combination.

     

    Table 2. Some Treatments for MDS

     

    Therapy

     

    Examples

    Observation with periodic blood count tests (watch and wait)

     

    Blood transfusions and iron chelation therapy

     

    Deferasirox (Exjade®), oral medication or deferoxamine mesylate (Desferal®)

    Administration of erythropoietin (EPO) and other blood cell growth factors

    		Epoetin alfa (Procrit®); darbepoetin alfa (Aranesp®) and granulocyte-colony stimulating factor (G-CSF; filgrastim; Neupogen®)

    Therapy with antithymocyte globulin (ATG)

     

    Thymoglobulin®; Atgam®

    Drug therapy 

     

    Azacitidine (Vidaza®); decitabine (Dacogen®); or lenalidomide (Revlimid®)

    Chemotherapy of the type used to treat acute myelogenous leukemia (AML)

     

    Cytarabine, daunorubicin, cytarabine, idarubicin, mitoxantrone, thalidomide

    Chemotherapy of the type used to treat AML, followed by allogeneic stem cell

    transplantation.

     

    Cytarabine, daunorubicin, cytarabine, idarubicin, mitoxantrone, thalidomide and allogeneic or reduced-intensity allogeneic stem cell transplantation

     

    Observation (Watch and Wait). Observation with periodic blood counts, also called "watch and wait," is generally recommended for a patient with

    • Low or intermediate-1 risk
    • A hemoglobin level greater than 10 g/dL and platelet counts greater than 50,000 per microliter (μL) to 100,000 per microliter (μL)
    • Without need for transfusion.

    These patients may be able to maintain their usual activity levels without therapy.

    Some patients have little change in status for years or decades. However, regular check-ups are important—there is a risk of progression to more severe forms of MDS or to AML. It is important for a patient to have an MDS specialist do periodic health status evaluations and monitor blood cell counts on a regular basis.

    Transfusions. Some patients need periodic red cell or platelet transfusions to relieve symptoms of fatigue and shortness of breath. The decision to give red cell transfusions is based on a combination of factors, including the patient's

    • Hemoglobin level
    • Symptoms
    • Other health complications, such as heart disease.

    Patients who have ongoing transfusion need to be monitored for "iron overload"—a condition that can damage the heart and liver—with a blood test called a "serum ferritin level." This test measures the body's store of iron.

    There are two medications (called "iron chelators") that are FDA-approved to remove excess iron in the body because of transfusion-dependent anemias:

    • Deferasirox (Exjade®) is an oral medication (a tablet to dissolve in liquid), taken once a day. 
    • Deferoxamine mesylate (Desferal®; DFO) is administered as a slow subcutaneous or intramuscular infusion for 8 to 12 hours per day, five to seven days per week.

    Platelet transfusions are typically required once a patient's platelet count is less than 10,000/μL. However, the major indication for platelet transfusion is unusual bleeding or bruising.

    LLS offers a free booklet Blood Transfusion, which provides information on transfusion of red cells, white cells, platelets and other blood components. 

    Erythropoietin (EPO) and Other Growth Factors. Some patients with decreases in blood cell counts can benefit from blood cell growth factors. 

    EPO is a hormone produced in the kidneys that stimulates red cell production. Red blood cell growth factors, called "erythropoietin-stimulating agents (ESAs)," such as Procrit® and Aranesp® are synthetic forms of EPO. These are given by injection under the skin (subcutaneous injection). Aranesp® is a longer-acting form of EPO than Procrit®.

    Most patients with MDS do not have low EPO levels—administration of ESAs is not useful in treating their anemia. However, all patients with MDS should have their EPO levels checked. ESAs are used to treat the 10 to 20 percent of patients who have anemia related to low EPO levels. For this patient population, usually lower risk patients, EPO will decrease transfusion needs and possibly improve survival. Some MDS patients with low EPO levels may not benefit from ESAs alone, but may need ESAs combined with white cell growth factors (G-CSF or GM-CSF) to increase their hemoglobin levels. Used alone, white cell growth factors have no role in treating MDS. However, G-CSF or GM-CSF may be used to support MDS patients with low neutrophil counts who develop infections. Prompt attention to infection or unexplained fever is important. Where bacterial or fungal infections are identified or suspected, appropriate antibiotics may be needed. Antiviral drugs may be used to treat certain viral infections.

    AMG 531 is a new drug being investigated in clinical trials for MDS patients with low platelet counts.

    Antithymocyte globulin (ATG; Thymoglobulin®; Atgam®). Some MDS patients have disease characterized by lymphocytes that destroy precursors of normal red cells, neutrophils and platelets. ATG is an immune globulin that is obtained from rabbits or horses and is given intravenously, destroys these lymphocytes and improves blood counts in some MDS patients. Fever and chills are common immediately after ATG administration. It is possible to identify patients with better (usually patients with low or intermediate-1 IPSS risk) or worse chances of responding to ATG. Patients should talk to their physicians about whether they might benefit from treatment with ATG.

    Drug Therapy. Three single-drug approaches—azacitidine, decitabine and lenalidomide—have been approved by the FDA for MDS treatment.

    Azacitidine (Vidaza®). A "hypomethylating" or "demethylating" agent. FDA-approved for the treatment of both low- and high-risk patients. It appears to help the patient's bone marrow begin to function more normally. It also kills the unhealthy cells in bone marrow that have been reproducing abnormally. Azacitidine is given by injection under the skin, usually for seven consecutive days, every four weeks.

    On average, about 40 percent of patients respond to azacitidine. The drug side effects include nausea, vomiting and diarrhea. The drug also temporarily reduces blood counts. Blood counts usually return to, or surpass, pretreatment levels prior to the next weekly series of injections. Oral azacitidine is being studied in phase 1 clinical trials to determine the most appropriate dose and its effectiveness.

    Decitabine (Dacogen®). Another hypomethylating/demethylating agent that is FDA-approved for low- and high-risk patients; given intravenously. Decitabine has been shown to reduce transfusion needs and improved blood counts in 30 to 40 percent of patients.

    Lenalidomide (Revlimid®). An FDA-approved drug and preferred therapy for the treatment of patients with transfusion-dependent anemia due to low- or intermediate-1-risk MDS associated with a deletion of chromosome 5q, either with or without additional cytogenetic abnormalities. About 20 to 30 percent of all MDS patients may have a 5q deletion. Lenalidomide is an immunomodulatory drug that is a nonneurotoxic and nonsedating derivative of thalidomide. It produces and maintains red cell transfusion independence in the majority of low-risk "del 5q" patients for about two years.

    Lenalidomide also reduces red cell transfusion requirements in low-risk patients without del 5q, but not as effectively as in patients with del 5q. Further study is needed to understand lenalidomide's effect on life expectancy and its benefits for patients with IPSS intermediate-2- or high-risk MDS, with or without del 5q.

    Chemotherapy. Patients in the intermediate-2 and high-risk IPSS categories may require treatment with the same type of chemotherapy that is used to treat acute myelogenous leukemia (AML). Planning this form of treatment also takes into account the patient's age and any coexisting medical conditions (see drugs listed in Table 2 above).

    The drugs may be given alone or in combinations of 2 or 3 different agents. In some cases, low-dosages are used. Initially, chemotherapy will make the patient's blood cell counts worse. This means that the doctor has to assess the benefits of intensive chemotherapy and consider both the

    • Severity of the patient's MDS
    • Chance that the patient will respond to the chemotherapy with a remission.

    Allogeneic Stem Cell Transplantation (Allotransplantation). Intensive radiation and/or chemotherapy, followed by allotransplantation, is the therapy with the best known potential to cure MDS for patients who are

    • Under age 55 
    • Intermediate-2 or high-risk
    • Have an HLA-matched stem cell donor (sibling or unrelated).

    About 40 to 50 percent of patients who have an allotransplant will be cured of their MDS. Outcomes of transplants with stem cells from matched-unrelated donors compare well to outcomes of transplants with matched-related donors. Some patients do relapse after transplantation; if relapse occurs it is usually within the first few years.

    Allotransplantation has been largely limited to patients with high-risk MDS because of the significant allotransplant-associated mortality rates (10 to 30 percent). Reduced-intensity allogeneic stem cell transplantation (also called nonmyeloablative allogeneic stem cell transplantation) may be an option for patients 55 to 70 years and older—the great majority of MDS patients.

    Reduced-Intensity Stem Cell Transplantation. Clinical trials are underway for reduced-intensity allotransplantation to determine the usefulness of this approach in older patients and sicker patients. Reduced-intensity transplants may be almost as effective in eliminating MDS as standard (fully myeloablative) allotransplants and may have lower mortality rates than those associated with standard allotransplantation.

    Patients being conditioned for a reduced-intensity allotransplant receive lower doses of chemotherapy drugs and/or radiation therapy in preparation for the transplant. The effectiveness of reduced-intensity transplantation is due to the "graft versus MDS effect" of the donor's lymphocytes rather than to high doses of chemotherapy and/or radiation therapy. Immunosuppressive drugs are used to prevent rejection of the graft.

    See the free LLS publications Blood and Marrow Stem Cell Transplantation and
    Cord Blood Stem Cell Transplantation for detailed information about stem
    cell transplantation.

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    Research and Clinical Trials

    LLS is funding research that could lead to treatments to repair damaged DNA in MDS patients.

    The goal of clinical trials for MDS is to improve treatment and quality of life and to increase survival. Patients' participation in clinical trials is needed to improve standard therapies so that all MDS patients can one day be cured of their disease. Some clinical trials are for all MDS-risk types; others are for either lower-risk or higher-risk MDS. Patients should speak to their doctors about the benefits of treatment in a specific clinical trial. Eligibility for a trial may depend on the patient's age, risk type and previous treatment for MDS.

    There are several clinical trials to study treatment with combinations of FDA-approved drugs, such as azacitidine or decitabine, and AML-type chemotherapy. The idea of combining agents is that since they each work in different ways to kill cancer cells, using them together may kill more MDS cells—or be as effective as standard MDS therapies, but with less-toxic side effects.

     

    Examples of Drugs and Drug Combinations in Clinical Trials for MDS Treatment

     

    Drug

     

    Study

     

    Arsenic trioxide (Trisenox®)

    Effectiveness in combination with azacitidine (Vidaza®) or with tipifarnib (Zarnestra®), a farnesyl transferase inhibitor (FTI), and gemtuzumab ozogamicin (Mylotarg®).

    Azacitidine (Vidaza®)

    To see if the duration of response improves with azacitidine maintenance for patients who achieve a complete or partial remission after intensive chemotherapy

    Clofarabine (Clolar®)

     

    Effectiveness in combination with AML-type chemotherapy.

    Lonafarnib (Sarasar®);

    tipifarnib (Zarnestra®)

    Effect on transfusion independence for patients who receive between 1 to 8 platelet transfusions every 4 weeks.

    Valproic acid (Depakene®)

    Being studied in combination with decitabine (Dacogen®).

    Vorinostat (Zolinza®)

    Being studied in combination with azacitidine (Vidaza®).

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    Childhood MDS

    Note: If you are interested in childhood MDS you may also want to read the information about adult MDS for more details about diagnosis and specific drugs used to treat MDS.

    MDS is diagnosed less frequently in children than in adults, and childhood MDS accounts for less than 5 percent of all blood cancers in diagnosed children. The median age at diagnosis is 7 years. Blood tests and bone marrow aspiration and biopsy are necessary to make a diagnosis of MDS.

    Subtypes of childhood MDS are based on the World Health Organization's (WHO) adult MDS classification. This classification is expected to help the diagnostic process and to lead to new and better treatments for patients.

    Primary MDS
    Refractory cytopenia (RC) is the most common subtype of primary childhood MDS.  About 50 percent of all children with MDS are diagnosed with RC. This subtype is difficult to diagnose and careful physical examinations, patient history and repeat bone marrow tests are necessary before an RC diagnosis can be confirmed. Primary MDS with increased blast count includes the RAEB and RAEB-T subtypes.

    For some children with RC, the disease can be monitored with periodic blood counts (also known as "watch and wait") without needing treatment. These children may need occasional transfusions to improve blood counts but their disease may remain stable for months and even years. Children diagnosed with the RAEB and RAEB-T subtypes generally need to start treatment soon after diagnosis.

    Treatment.  A large proportion of children with RC are cured with an allogeneic stem cell transplantation. Treatment with allogeneic stem cell transplantation is also estimated to cure about 50 percent of children with advanced primary MDS (RAEB and RAEB-T).

    Allogeneic stem cell transplantation is the only curative treatment option at present for childhood MDS. It is an option for children who have either a matched related stem cell donor or a suitable unrelated donor. For children with RC who are not transplant-eligible, certain study findings show that immunosuppressive therapy, using cyclosporine A and anti-thymocyte globuline, has led to improved blood counts, partial responses, and  in some cases complete responses. However, further study is needed to determine the long-term results of this treatment.

    Secondary MDS                                                                                     Secondary MDS may occur after children have received radiation therapy or chemotherapy treatments for other cancers. This is also known as therapy-related MDS (tMDS). Between 7 and 18 percent of childhood MDS cases are therapy related.

    Secondary MDS may also occur when children have certain uncommon congenital bone marrow disorders such as Fanconi anemia, severe congenital neutropenia or Schwachman-Diamond syndrome. Secondary childhood MDS has also been noted in some cases where there is a history of MDS in a first-degree relative. (mother, father, brothers or sisters, who are related by blood).

    Treatment. In general, children with therapy-related MDS (tMDS) have less favorable outcomes compared to those with primary MDS. However, allogeneic stem cell transplantation has improved survival for tMDS patients.

    Allogeneic stem cell transplantation may be used to treat some children with secondary MDS associated with congenital bone marrow failure disorders, depending on whether or not the transplant is the treatment approach for the associated congenital bone marrow disorder. 

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    Get More Information

    New therapies to treat adult and childhood MDS are currently being studied in clinical trials. Please contact the Information Resource Center (IRC) at (800) 955-4572 to help you locate a clinical trial for childhood MDS. You can also find clinical trials near you through the LLS-supported TrialCheck® website.

    For more information on stem cell transplantation, see the free LLS publications Blood and Marrow Stem Cell Transplantation and Cord Blood Stem Cell Transplantation

    LLS offers ongoing education programs featuring leading MDS specialists discussing the latest issues in the diagnosis and treatment. Visit the Myelodysplastic Syndromes Education Series page to find out about upcoming and archived programs. These programs are offered at no charge.

    These Myelodysplastic Syndromes Education Program Highlights may be of interest:

    Myelodysplastic Syndromes, MDS: Exploring Current and Emerging Therapies

    Please visit our Interactive Personal Journeys page to watch the experiences of a myelodysplastic syndromes survivor and his wife and caregiver, with expert insights provided by Stephen P. Nimer, MD, Memorial Sloan-Kettering Cancer Center.

    Further details of treatment and supportive care and the beneficial and adverse effects of treatment may be obtained from the free LLS booklet about MDS. View or order Myelodysplastic Syndromes online.

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    Contact Us

    The Leukemia & Lymphoma Society
    1311 Mamaroneck Ave.
    White Plains, NY 10605

    Email us infocenter@LLS.org or call the Information Resource Center at (800) 955-4572.

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    Helpful Links

     

     



    MDS Facts & Statistics - Myelodysplastic syndromes (MDS) are a group of diseases of the blood and marrow, with varying degrees of severity, treatment needs and life expectancy. It is estimated that there will be 11,000 new cases of MDS in 2008 and about 25,473 people are living in the United States today with MDS.

    CMML - Chronic myelomonocytic leukemia (CMML) is an uncommon blood cancer that has features of two other types of blood cancers. For this reason, the World Health Organization (WHO) classified CMML as a "mixed myelodysplastic/ myeloproliferative disease." This relatively new classification (2001) is expected to lead to a better understanding of the disease and to the development of more effective treatments.

    JMML - Juvenile myelomonocytic leukemia (JMML) is an uncommon blood cancer that has features of two other types of blood cancers called “myelodysplastic syndromes” (MDS) and “myeloproliferative disorders” (MPDs). For this reason, the World Health Organization (WHO) classified this disease as a “mixed myelodysplastic/myeloproliferative disease.”



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