Supportive Therapy for Myelodysplastic Syndromes

Supportive therapies are treatments that help treat (or prevent) the symptoms or complications of myelodysplastic syndromes (MDS), as opposed to treating the MDS directly. Supportive therapy might be used alone or along with other treatments for MDS. The main purpose of this type of treatment is to improve the comfort and quality of life for someone diagnosed with cancer no matter what stage the cancer or the goal of treatment might be. You might also hear supportive care referred to as palliative care, symptom management, or comfort care.

For example, for many patients with MDS, one of the main goals of treatment is to prevent the problems caused by low blood cell counts.

Treating low red blood cell counts (anemia)

Low red blood cell counts (anemia) can cause severe fatigue and other symptoms. Patients with MDS and anemia that’s causing symptoms might benefit from getting injections of a manmade version of the growth factorerythropoietin, which can sometimes help the bone marrow make new red blood cells.

If this isn't helpful, red blood cell transfusions might be needed. Some people are concerned about a slight risk of infections (such as hepatitis or HIV) spread by blood transfusion, but this possibility is very unlikely, and the benefits of the transfused cells greatly outweigh this risk.

For people with some types of MDS who haven’t been helped by erythropoietin growth factors and who need regular blood transfusions, treatment with a drug called a red blood cell maturation agent, such as luspatercept, might be an option. This type of drug can sometimes help lower the number of transfusions a person needs.

Treating iron build up from blood transfusions

Blood transfusions can cause excess iron to build up in the body. The iron can build up over time in the liver, heart, and other organs, affecting how they function. This is usually seen only in people who receive many transfusions over a period of years. Patients at risk for iron overload are often advised to avoid taking iron supplements or multivitamins that contain iron.

Drugs called chelating agents, which bind with the iron so that the body can get rid of it, can be used in patients who develop iron overload from red blood cell transfusions (unless they have poor kidney function).

• Deferoxamine (Desferal) is usually given as an infusion under the skin, using a small, portable pump. This can be inconvenient because the infusion must be done slowly (over at least 8 hours) each day or on most days of the week. 
• Deferasirox (Exjade, Jadenu) is a newer drug that is taken by mouth (as a tablet, dissolved in juice or water, or sprinkled on food) once a day. 

For more information about red blood cell transfusions, see Blood Transfusion and Donation.

Treating low platelet counts

MDS patients with low platelet counts might have problems with bleeding or bruising easily. The options for treating a shortage of platelets might include platelet transfusions or treatment with certain growth factor drugs. If bleeding is not helped by these treatments, another option might be treatment with a drug called an antifibrinolytic agent, such as aminocaproic acid (Amicar).

For more information about platelet transfusions, see Blood Transfusion and Donation.

Treating low white blood cell counts

Patients with low white blood cell counts are more likely to get infections, and the infections are more likely to be serious. It's important to avoid cuts and scrapes, and take care of them right away if they do happen. Patients should tell their doctors right away about any possible signs of infection, such as fever, signs of pneumonia (cough, shortness of breath), or urinary tract infection (burning when urinating).

Doctors typically treat known or suspected bacterial infections with antibiotics. For serious infections, a white blood cell growth factor may also be used. This drug can raise the white blood cell count to help fight the infection.

See Infections in People With Cancer for more detailed information about infections and how to lower your risk.