Myelodysplastic syndromes (MDS) treatment and side effects
Myelodysplastic syndromes (MDS) non-intensive treatment
Treatment for MDS can be classed as low-intensity or high-intensity.
Low-intensity or non-intensive treatment aims to slow the progression of the disease. It may be considered if your blood counts are quite low or falling, or if there are signs that the disease is developing into leukaemia. The idea is to treat the disease with as few side effects as possible, thereby maintaining a good quality of life. These treatments will not cure your MDS but may ‘modify’ the disease. These treatments are usually given as an outpatient.
Azacitidine
Azacitidine is a hypomethylating agents (HMA). HMAs work on the behaviour of cancer cells at the DNA level and can turn genes on and off. Azacitidine can slow the progression to leukaemia. HMAs are currently used in high-risk MDS patients who can’t have a stem cell transplant. Azacitidine is usually given as an injection under the skin. Side effects can include:
- mild nausea
- diarrhoea or constipation
- skin irritation at the injection site
- becoming more prone to infections
We have more information on managing the side effects of blood cancer treatment.
Lenalidomide
If you have a certain type of MDS (MDS with isolated del(5q)), you may be offered lenalidomide if you are anaemic.
Lenalidomide is taken orally as a capsule and works in several ways to suppress the MDS cells, including altering the immune system.
On starting the treatment, your blood counts fall before a response is seen. During this early stage, you may need blood transfusions, platelet transfusions or growth factors (G-CSF).
Other side effects can include:
- rashes
- fatigue
- diarrhoea
- a small increased risk of blood clots.
As lenalidomide can cause birth defects, you must avoid getting pregnant whilst taking the drug.
Immunosuppressive therapy
In a small number of people with MDS, the number of the bone marrow cells is unusually low (called hypoplastic). This is similar to a blood disease called aplastic anaemia. Some people are given drugs that suppress the immune system for this, such as anti-thymocyte globulin (ATG) or ciclosporin.
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