Ask the Pharmacist

Q: I saw my doctor because of this ongoing overwhelming fatigue I have been experiencing. I figured I must be lacking in iron or have a low thyroid level but she ran some tests and said I have a myelodysplastic syndrome. What is that?

A: Myelodysplastic syndromes are a group of diseases now classified as forms of cancer although for many years they were considered to be of low malignant potential and were referred to as a form of pre-leukemia. They occur when the normal production of one of your blood cells is disrupted leading to the creation of immature blood cells that either die promptly or don’t function normally.

The type of blood cell affected determines which of the syndromes you have. There are three main types of blood cells: the white blood cells that fight infection; platelets that are involved in the ability of blood to clot; and red blood cells that are responsible for carrying oxygen to your cells.

While they can occur at any age, myelodysplastic syndromes tend to be seen more frequently in those over the age of 60, and are more prevalent in men than women. While there is no known direct cause for these disorders, there are some people who are more likely to be diagnosed than others.

Risk factors for this include exposure to high levels of radiation, having been previously diagnosed with one of several rare genetic disorders such as Fanconi anemia, a history of smoking, previous treatment for other types of cancer with a few specific chemotherapy drugs or radiation, and work exposure to such environmental toxins as benzene, petroleum products, pesticides, fertilizers or chemicals used in the manufacture of rubber.

Since myelodysplastic syndromes are progressive in nature, many present with no symptoms or only mild symptoms initially. These will worsen over time as a greater percentage of blood cells is affected.

As we mentioned before, the particular symptoms experienced are dependent on the type of cells affected but can include such nonspecific ones as fatigue, fever, frequent infections, easy bruising or bleeding, paleness, shortness of breath, a general feeling of being not well, and abdominal discomfort.

Diagnosis usually involves blood tests which measure the number and quality of your various blood cells, and a biopsy of the bone marrow. Prognosis depends on a variety of factors, with some people doing very well for many years while others will exhibit a more aggressive form and require treatment early on. About one-third will eventually progress to acute myeloid leukemia (AML).

In general, the outcome can be predicted by looking at: the blood cell count (the lower the number, the worse the likely outcome), chromosomal changes the patient may have (multiple mutations or an abnormal Chromosome 7, are poor signs), and the presence of immature blood cells within the bone marrow (once again a high number is not a good thing).

Treatment is aimed at relieving symptoms, slowing or stopping the myelodysplastic syndrome from developing into AML, and improving the quality of life. Often, treatment options are combined.

The mainstay of therapy is the use of chemotherapy (or anti-cancer drugs) and/or radiation to destroy the cancer cells. This may be combined with a transfusion, the administration of growth factors or other drugs, all aimed at either elevating the blood cell counts or at least preventing some of the problems associated with low blood cell counts.

A stem-cell transplant is also a treatment option but is usually reserved for younger people or those with highly-aggressive forms of the disease, due to the risky nature of the procedure.

There are ongoing clinical trials which offer new hope for those diagnosed with one of these cancers, should the available treatment options prove unsuccessful.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/?fref=ts