How is MDS treated?

Treatment will depend on your type of MDS, your risk group, and whether you have any other health conditions.

The aim is to get the number and type of blood cells in your bloodstream back to normal, and manage symptoms with supportive treatment (see below).

If your MDShas only a low risk of transforming into cancer, you may not need any treatment at first, and may just be monitored with regular blood tests.

Supportive treatment

Symptoms of MDS can be controlled with a combination of the following treatments:

• a blood transfusion the drip may contain red blood cells or platelets, depending on which cells have been affected
• drugs to get rid of the excess iron in your blood (which builds up after a lot of blood transfusions)
• injections of growth factor drugs such as erythropoietin (which increases red blood cell count) or G-CSF (which increases white blood cells) to encourage your bone marrow to make more blood cells
• antibiotics to treat infections, if your white blood cell count is low

Immunosuppression treatment

Drugs such asanti-thymocyte immunoglobulin (ATG) and ciclosporin reduce the activity of the immune system, allowing your bone marrow to make blood cells. It can also help to control symptoms.

However, these drugs are not suitable for everyoneand work best in young peopleandthose who don'thave a chromosome change associated with their condition.

Chemotherapy

Ifyou're at ahigher risk of developing AML, you will need prompt treatment with chemotherapy or a stem cell transplant (see below).

Chemotherapyinvolves taking drugs that destroy the immature bloodcells by disrupting their growth. The drugsare taken either as a tablet or an injection.

If you have ahigher risk of developingAML, your chemotherapy treatment will probably be similar to that used to treat AML. Readabout the treatment of AML .

You will probably have one or a combination of the following chemotherapy drugs:

• cytarabine
• fludarabine
• daunorubicin
• clofarabine
• azacitidine (this is for people with higher-risk MDS who are unable to have a stem cell transplant)

Stem cell (bone marrow) transplant

The only way to cure MDS is to have intensive treatment with a stem cell transplant from a donor but this isn't suitable for everyone.

A stem cell transplant will generally only be offered if you areyoung and in reasonably good health (apart from your MDS),as it'sa very intensive treatment.

It helps if you have a suitable donor in your family(a close relative, such as a brother or sister), althoughin some cases, it's possible tohave a stem cell transplant using an unrelated donor with a matching tissue type.

Treatment involves destroying your own bone marrow cells with chemotherapy and sometimes radiotherapy, before having stem cells from a donor fed into your bloodstream via a drip.

Biological therapies work by affecting the way your immune system functions.

Lenalidomide can be used to treat MDS in people with a specific genetic mutation, called an isolated deletion 5q cytogenetic abnormality.

This abnormality can lead to severe anaemia, which requires regular blood transfusions.

Read the NICE guidelines on lenalidomide for treating myelodysplastic syndromes associated with an isolated deletion 5q cytogenetic abnormality .

Clinical trials

The treatment of MDS is constantly evolving and new drugs are being tested all the time.

You may be offeredthe chance to enter a clinical trial. Find out more about:

• joining a clinical trial
• clinical trials for myelodysplasia