Myelodysplastic Syndrome: Therapy

Supportive therapy

Supportive therapy refers to measures that are used in a supportive manner. They are not intended to cure the disease, but to accelerate the healing process and alleviate symptoms. If there is a deficiency of erythrocytes (red blood cells) or platelets (thrombocytes) in the peripheral blood, blood transfusions may be considered:

  • Transfusion of leukocyte-depleted red cell concentrates, depending on the clinical condition (the Hb value is not decisive!).
  • Transfusion of platelet concentrates.
    • Indication: clinical signs of bleeding (prophylactic administration is indicated only in fever and severe infections).

Blood transfusions bring more free iron into the body of the recipient, which over time, especially in patients who receive many blood transfusions, can lead to secondary siderosis (iron overload) and thus to a deposition of iron in the organism. In the case of impending or manifest siderosis, the administration of iron chelators is therefore recommended. They bind the excess iron in the body, which can then be excreted. The following iron chelators are usually used:

  • “Deferasirox” (oral) or “deferoxamine” (subcutaneous or intravenous).
  • Control parameter: Ferritin in serum
  • In about 20% of cases, there is an improvement in blood count.

General measures

  • In case of platelet deficiency: do not take anticoagulants (anticoagulants) such as acetylsalicylic acid (ASA)! They further reduce the already limited functioning blood clotting, which increases the risk of (internal) bleeding.
  • Avoidance of environmental stress:
    • Toxic (poisonous) substances such as benzenes and solvents (paints, varnishes), kerosene.

Conventional non-surgical therapy methods

For the therapy of high-risk myelodysplastic syndrome, allogeneic stem cell transplantation (more precisely: hematopoietic stem cell transplantation; HSCT; blood stem cell transplantation) – as the only therapeutic measure with a prospect of cure (in the presence of an HLA-identical family or outside donor) – can be considered.

  • Indications:
    • High-risk patients <65 years and good general condition of the patient.
    • In relapse (recurrence of the disease) after stem cell transplantation.
    • Younger patients with low-risk and severe thrombocytopenia (deficiency of platelets) and/or neutropenia (decrease in neutrophil granulocytes) and/or molecular markers indicating a poor prognosis

For this purpose, the patient should be free of infection and in a general condition that allows this intensive therapy. By DNA sequencing of bone marrow cells with reduction to 40 genes, the prognosis after allogeneic stem cell transplantation can be predicted relatively well already 30 days after treatment.

Vaccinations

The following vaccinations are advised:

  • Flu vaccination
  • Pneumococcal vaccination: immunocompromised individuals should be vaccinated sequentially with the 13-valent conjugate vaccine PCV13 and six to 12 months later with the 23-valent polysaccharide vaccine PPSV23 against pneumococcus.

Regular checkups

  • Regular medical checkups

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
    • A total of 5 servings of fresh vegetables and fruit daily (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
    • Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
    • High-fiber diet (whole grains, vegetables).
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

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