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MDS Low Risk
MDS Low Risk
Haematological Pathway
for
Demographics
- The overall incidence of MDS is 4 per 100,000 increasing to >30 per
100,000 in patients over 70 years old.
Diagnosis
- Full blood count with differential WBC including monocyte count
- Blood film analysis
- Reticulocyte count
- Bone Marrow aspirate and trephine biopsy
o Morphology
o Flow cytometry quantification of blast population
o Iron stain
o Reticulin stain
o Cytogenetic analysis
- Additional investigations:
o EPO level (if Hb <100 g/l)
o JAK2 status (in suspected cases of MDS/MPN overlap syndromes)
o PNH screen
o CMV, Hepatitis B/C, HIV
Treatment
All new MDS cases should be discussed at an MDT.
All MDS patients should be evaluated for suitability for entry into
local/regional clinical trials.
Further support for patients can be accessed via the MDS Patient Forum
(www.mdspatientsupport.org.uk)
Supportive Care
- Supportive care remains the mainstay of treatment for the majority of
patients with Low/Int-1 risk MDS.
- Local guidelines should be followed with respect to antimicrobial
prophylaxis in neutropenic patients.
- Red cell transfusions for symptomatic anaemia.
- Platelet support for symptomatic thrombocytopenia.
- G-CSF may be considered for patients with low risk disease and
recurrent infections.
- ESAs and iron chelation are discussed in further detail below.
Immunosuppressive Therapy
- ATG (horse) followed by ciclosporin may be considered in patients with
Low/INT-1 MDS who are less than 60 years of age and have a normal
karyotype or trisomy 8.
- Ciclosporin therapy alone may be considered for older patients
particularly in cases with hypocellular BM or associated autoimmune
phenomena.
Monitoring
- Monitoring should be tailored according to the patients symptoms and
degree of blood count abnormality.
- Ferritin should be monitored in patients potentially suitable for iron
chelation or allo-HSCT.
Discharge
- Patients with a confirmed diagnosis of MDS should remain under the
care of a haematologist.
Reference
BCSH Guideline: Guidelines for the Diagnosis and Management of Adult
Myelodysplastic Syndromes (Awaiting publication)
/conversion/tmp/scratch/365008007.doc