July 23rd, 2012 | The Blog
Myelodysplastic syndrome (MDS) is a serious, life-threatening illness, which has made the headlines since Good Morning America personality, Robin Roberts, reported that she has been diagnosed with the disease.
What Is MDS?
Myelodysplastic syndrome is pre-leukemia, which develops 5 to 7 years after a patient is treated with chemotherapy or radiation for a different cancer, typically breast or lymphoma. It has been reported up to 20 years after a patient receives treatment. There is no predictor as to who will be affected by this cancer.
Ironically, treating one cancer can cause another, specifically MDS. Here is what happens: chemotherapy and radiation both cause dramatic, irreversible damage to DNA found in the cells of the bone marrow. Damage to DNA causes a potential increase in new cancers.
Statistics About MDS
- It is relatively rare; occurs in 1 to 2 percent of cancer patients. Twenty years ago, when Hodgkin’s disease was first treated with harsher drugs, MDS occurred in 4 to 5 percent of patients.
- Overall, only 20 percent of bone marrow transplant patients are cured of MDS.
- Children and younger adults, those into their 50s, have a higher cure rate of about 30-40 percent after transplant.
- Complications after the bone marrow transplant cause death in 20-30 percent of patients.
Typical Treatment Protocol
MDS is difficult to cure. It requires a strong and harsh treatment protocol. A bone marrow transplant (BMT) is the essence of the treatment. A transplant using donor cells is called an allogeneic transplant. Who are the donors?
- A brother or sister with the same parents has a 25 percent chance of being a suitable match.
- 70 percent of patients do not have a suitable family member donor.
- An unknown donor from the National Marrow Donor Program.
The treatment regime for a BMT follows some version of this protocol:
- Search for an appropriate donor, either a family member match or unrelated donor through a registry. The physician or transplant program coordinator orchestrates this critical task.
- Insertion of a central venous line for the safe administration of pre-transplant treatment and, ultimately, the bone marrow transplant or cord blood cells. It is also used to draw blood for lab analysis. Hickman or Broviac catheters are the most popular choices.
- In all cases, high doses of chemotherapy are administered pre-transplant. Radiation is sometimes used in addition to chemotherapy. This regime lasts for 4 to 10 days and is done for three basic reasons: Destroy the cancer cells, destroy the blood-making cells in the bone marrow and make room for the newly transplanted cells, and destroy the recipient’s immune system so it does not attack or reject the transplanted donor cells.
- When day zero (transplant day) arrives, the bone marrow or cord blood cells are infused over about one hour through the central line. Some patients are sedated during the infusion, as anxiety levels are high.
- Engraftment occurs when the donor cells settle into the bone marrow and begin to grow and produce new red blood cells, white blood cells and platelets. This usually happens between days 0-30 and is a major milestone in the process.
- Low blood counts render the patient at risk for an infection, especially during the first 100 days after the transplant. Caution must be taken to protect the patient. Some protocols include a preventive antibiotic regime to avoid infection.
There are a host of complications involved with bone marrow transplant. There are three major concerns of which to be aware:
- Infection: A weakened immune system due to the pre-transplant chemotherapy predisposes the patient to infection at the central line insertion site, urinary tract, mouth, blood and lungs.
- Acute graft-versus-host disease (GVHD): This is a common complication in which the transplanted (graft) cells attack the body of the patient (host) during the first 100 days after the transplant.
- Chronic GVHD: This is the same complication as acute GVHD, except it occurs after the 100-day mark.
- Graft failure or rejection: When the donor cells are not accepted by the recipient and no blood cell production or engraftment occurs after 42 days, the transplant is considered a failure. This complication occurs in only 5 percent of patients. The treatment for graft failure or rejection is to undergo another transplant, either from the same donor or a different one. Cord blood transplant failure always necessitates using a different donor for a second transplant.
Be The Match
The National Marrow Donor Program (NMDP) controls this life-saving donor registry. Over the 25 years the Be the Match program has been in existence, there have been 50,000 transplants arranged. The registry program allows people to donate bone marrow or umbilical cord blood to the registry. Currently, there is access to 16.5 million bone marrow and 550,000 cord blood units at the registry. In turn, patients with life-threatening blood cancers like lymphoma, leukemia and MDS can find a donor match to receive a bone marrow transplant.
Joining the registry to be a potential donor is simple and kind. There are donor drives around the country or you can register online and have the Buccal Swab Kit sent to your home. Being tissue typed as a donor involves only a cheek swab. Go to the Be The Match website for detailed information.