A bone marrow or cord blood transplant is the only cure for MDS at this time. If transplant is an option for you, your doctor can talk with you about your risks and your chances of remaining disease-free with transplant. A transplant begins with chemotherapy, with or without radiation, to destroy the diseased cells and marrow. The transplant replaces diseased blood-forming cells with healthy ones.
The type of transplant used for MDS is an allogeneic transplant, which uses healthy blood-forming cells from a family member, unrelated donor, or umbilical cord blood unit.
At the start of the transplant process, a patient gets chemotherapy to prepare his or her body for the treatment. Then the replacement cells are infused into the patient’s bloodstream. From there, the cells find their way into the bone marrow, where they start making healthy red blood cells, white blood cells, and platelets. The entire process, from the start of chemotherapy or radiation, until hospital discharge, can last weeks to months, followed by many months of recovery at home.
Understanding if transplant would help your MDS
Whether a transplant is right for you depends on several things, including your age and overall health, what type of MDS you have, and the risk score for your MDS.
Your risk score is based on several aspects of your disease, including how many blasts (immature white blood cells) are in your marrow, whether you have low blood counts, and cytogenetic testing. Cytogentic testing is when a doctor looks at the chromosomes in the diseased cells. Chromosomes are thread-like strands of DNA that carry genetic information about your body. Certain changes in the chromosomes can predict whether you have a lower-risk or higher-risk disease. Your doctor can tell you what risk score your MDS has.
In the newest international scoring system, MDS risk scores are grouped into five categories: Very Low, Low, Intermediate, High and Very High. Patients in the low and very low risk groups have mild disease and may not receive any treatment at all ("watch and wait"). But, they will likely have frequent blood tests to see if the MDS is stable or becoming worse.
Patients in all other categories will likely receive one or more drugs that can help treat the MDS to improve blood counts. These drugs cannot cure MDS, but they help increase blood counts for some patients and improve a patient’s quality of life. Sometimes, these drugs are used to keep patients stable until they are ready for an allogeneic transplant.
There are medical guidelines for when someone should be referred for a transplant consultation, whether or not you might need a transplant at that time. An allogeneic transplant is an option for MDS patients in the Intermediate, High or Very High risk categories. Talking to a transplant doctor is especially recommended if your disease has any of the following features.1
- MDS caused by another treatment, such as chemotherapy for another cancer
- Low blood cell counts that do not improve with drugs
- Changes in the chromosomes of the cells in the marrow that predict a poor result
- Dependence on red blood cell or platelet transfusions
1. Recommended Timing for Transplant Consultation. Guidelines developed jointly by National Marrow Donor Program/Be The Match and the American Society for Blood and Marrow Transplantation (ASBMT). Available at: marrow.org/md-guidelines