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You Can Live Comfortably With MDS: This rare blood disorder is more common in older adults.

You may not have heard of myelodysplastic syndrome (MDS), but it's a problem older adults should be aware of given that age increases your risk for it--86 percent of people with MDS are age 65 and older.

In MDS, the number of healthy, functional blood cells decreases. The prognosis is quite variable--many people with the condition live for years without symptoms or just needing supportive treatment, while some develop acute myeloid leukemia (AML), a rapidly progressing blood cancer that affects immature white blood cells.

Bone Marrow Problem MDS occurs due to a problem with the development of blood cells in bone marrow, the fatty tissue found in the hollow interior of certain bones. Bone marrow is where stem cells are manufactured. These immature cells differentiate (develop) into specific kinds of cells, including the red blood cells that transport oxygen in the body, the white blood cells that fight infection, and the platelets that assist with blood clotting. However, in MDS some stem cells don't mature properly. "Instead, they may die and accumulate in the bone marrow, or may enter the bloodstream but have a shortened life span and function poorly," says Shyamala C. Navada, MD, assistant professor of hematology/oncology at Mount Sinai.

Over time, the number of immature, defective cells in the bone marrow of a person with MDS may exceed the number of healthy cells, and result in lower numbers of red blood cells, white blood cells and platelets in the blood. This eventually may cause symptoms such as anemia, due to reduced numbers of red blood cells; an increased susceptibility to infections, due to too few white blood cells; and a greater risk of bleeding because of too few platelets.

What Causes MDS? It isn't clear what causes MDS, but it is likely that stem cell mutations play a role. Risk factors for the condition include long-term exposure to benzene, a chemical present in cigarette smoke, gasoline and motor vehicle exhaust fumes, and used in the manufacture of plastics, lubricants, rubber, detergents, and pesticides. People who have previously been treated with chemotherapy or radiation also may develop MDS (this "secondary" form is more likely to develop into AML).

Diagnosing and Treating MDS Most people are initially suspected to have MDS because routine blood counts reveal anemia, low platelets, or low white blood cell counts. Occasionally they become symptomatic and the disorder is identified during the workup. Definitive diagnosis requires a bone marrow biopsy.

People who develop MDS-related symptoms typically receive supportive treatment. "These individuals are monitored and, if necessary, given blood and/or platelet transfusions and injected growth factors, which stimulate the development of blood cells and decrease the need for transfusions," Dr. Navada says. Red blood cell growth factors include epoietin alfa (Epogin[R], Procrit[R]) and darbepoetin alfa (Aranesp[R]), while people with low white blood cell counts may receive filgrastim (Neupogen[R], Zarxio[R]), pegfilgrastim (Neulasta[R]), or sagramostim (Leukine[R]). "If your blood count or symptoms worsen, you may be given disease-modifying drugs," Dr. Navada adds. "These can improve blood counts, decrease transfusions, reduce the risk of AML, and improve quality of life and survival." Options include azacitidine (Vidaza[R]), decitabine (Dacogen[R]), and lenalidomide (Revlimid[R]).

A stem cell transplant can cure MDS, but older adults often have comorbidities that preclude them from being transplant candidates. "Standard stem cell transplants also require that existing bone marrow be destroyed with chemotherapy or radiation, and side effects can be severe," Dr. Navada adds. "Some older adults may be candidates for a reduced intensity stem cell transplant; however, this has a greater risk of relapse compared to normal intensity regimens."

Taking Care of Yourself There are strategies that can help you live comfortably with MDS. Take precautions against infections by frequently washing your hands with soap and hot water, and always before food preparation. Carry an alcohol-based hand sanitizer with you when you go out, in case you are unable to wash your hands. Thoroughly wash fruits and vegetables before peeling them (in fact, it may be advisable to avoid eating fruits and vegetables you can't peel, particularly lettuce). Ensure that meat and fish are thoroughly cooked.

If your white blood cell count is low, avoid close contact with people who are ill, and unvaccinated children who may have been exposed to common childhood viruses, such as chicken pox. Keep in mind too that grandchildren may have been recently immunized with live vaccines that could present a risk, such as the measles, mumps and rubella (MMR) vaccine. If in doubt, ask your doctor if you should keep your distance. Alert your doctor about symptoms that may indicate an infection (such as a fever and/or chills) or bleeding (such as a cut that won't stop bleeding, bloody urine, and/or dark, "tarry" stools).

A nutritious diet and sufficient sleep can help you overcome the fatigue that typically accompanies MDS. Ask for help from family and friends if you are feeling particularly drained, and balance rest with physical activity, since the latter can help boost your energy and mood. Also consider reaching out to a support group (see Find Out More)--other people with MDS may be able to offer useful tips on coping with the condition.

FIND OUT MORE

* The Myelodysplastic Syndromes Foundation (www.mds-foundation.org) has information on MDS, along with details of local support groups and an online community.

Caption: Blood cells andplatelets differentiate from stem cells that are manufactured in bone marrow. In MDS, this process doesn't work properly.
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Title Annotation:WELLBEING
Publication:Focus on Healthy Aging
Date:Aug 27, 2019
Words:917
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