Myelodysplastic Syndrome

Myelodysplastic Syndrome - What it is

Myelodysplastic syndrome (MDS) is a group of disorders that cause abnormal maturation of your blood cells in the bone marrow, leading to low levels of one or more of the blood cells.

There are many subtypes of MDS. Some cases can be stable over many years, while others carry a high risk of becoming acute myeloid leukemia (AML).

Myelodysplastic Syndrome - Diagnosis

MDS is first suspected when there is a low blood count on a blood test. If your doctor suspects that you have MDS, they will recommend for you to undergo a bone marrow biopsy to confirm the diagnosis. From the bone marrow sample, we will look at the appearance of the early cells under the microscope to see if they appear abnormal. This is called dysplasia. They will then decide the number of types of blood cells that have dysplasia, percentage of cancer cells (or blasts) and presence or absence of chromosome abnormalities or gene mutations, to estimate the likelihood of the condition transforming to AML.

Myelodysplastic Syndrome - Treatments

Based on the blood counts and findings from the bone marrow biopsy, patients can be categorized into lower and higher risk MDS. These categories are useful to help predict risk of progression to acute leukemia and estimating survival.

Treatment strategy for MDS will take into consideration the disease risk category, patients’ symptoms and fitness for treatment.

Patients with MDS may receive one or more of the treatment options below

Blood transfusions

Transfusions of red blood cells or platelets are given to relieve symptoms or when the numbers are dangerously low
In SGH, most patients are able to receive their regular blood transfusions as an outpatient at our Haematology Centre

Haematopoietic growth factors

The most commonly prescribed growth factor is high dose erythropoietin which helps to stimulate red cell production and reduce transfusion needs.

Immunosuppressive therapies

Lenalidomide – some patients have a specific subtype of MDS with a chromosomal abnormality called deletion 5q. They may be prescribed an oral therapy called lenalidomide to improve their blood counts
In selected patients with MDS, especially those with low risk, doctors may prescribe a combination of immunosuppressive therapies such as ciclosporin and anti-thymocyte globulin

Hypomethylating agent

The most commonly used hypomethylating agent in Singapore is azacitidine.
It is a type of low intensity chemotherapy that has been shown to enable bone marrow cells to develop more normally and may help to delay progression to acute leukemia and prolong survival.

Allogeneic stem cell transplant

It is the only treatment that has been shown to cure MDS but it is associated with many severe complications
It is usually recommended to patients with high risk disease and are fit for intensive treatment

As the oldest and most established haematology department in Singapore, we have a dedicated group of doctors who specialize not only in the treatment of myelodysplastic syndrome, but also have access to new medication through clinical trials. For high-risk patients and in event of transformation to leukaemia, suitable patients will be transition to the haematopoietic stem cell transplant team.