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Diagnostic approach to myelodysplastic syndromes. MDS, myelodysplastic syndromes; PCP, primary care physician.
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Myelodysplastic syndromes (MDS) are probably the most common hematologic malignancies in adults over the age of 60 and are a major source of morbidity and mortality among older age groups. Diagnosis and management of this chronic blood cancer has evolved significantly in recent years and there are Food and Drug Administration-approved therapies tha...
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... Diagnosing MDS can be challenging as patients are often asymptomatic and the disease morphology is non-specific, especially in its early stages [1]. For example, anemia is commonly observed in the elderly and is often unrelated to a hematological problem [21]. The diagnosis of MDS relies on detailed assessment of bone marrow and peripheral blood cytological composition using hematological techniques. ...
Myelodysplastic syndromes (MDS) are characterized by ineffective hematopoiesis, leading to hematopoietic precursor cell apoptosis and peripheral blood cytopenias. Anemia is the most frequently experienced cytopenia and is the main cause of MDS symptoms, with fatigue and dyspnea contributing to reduced quality of life and increased morbidity. As MDS disease course and prognosis is influenced by disease factors, prognostic scoring systems have been developed for MDS to aid clinical and therapeutic decisions following diagnosis. Erythropoiesis- stimulating agents (ESAs) have been used for many years to treat anemia in patients with lower-risk MDS without chromosomal abnormalities. The use of ESAs is recommended by international clinical practice guidelines, due to the large body of evidence demonstrating their effectiveness in lower-risk MDS. In March 2017, the European Medicines Agency approved epoetin alfa for the treatment of anemia in lower-risk MDS patients, based on the results from a Phase 3 clinical trial and three European registry studies. The effectiveness of biosimilar epoetin alfa (Binocrit ® , Sandoz) to correct anemia in lower-risk MDS patients has also been demonstrated in a retrospective, single-center, observational study. The recent approval of epoetin alfa by the EMA in this setting will provide clinicians with a welcome, approved treatment option for lower-risk MDS.
... 17,18 The most common treatment goals in MDS are to prevent or delay leukemic transformation and optimize health-related quality of life. 19 The only curative treatment is with allogenic stem cell transplantation, which is often not feasible given the age and comorbidities of the affected patient. Treatment with DNA methyltransferase inhibitors, such as azacitidine or decitabine, help reverse the epigenetic aberrations by removing methylation from the promoter regions, increasing transcription and normalization of key proteins. ...
Azacitidine, a deoxyribonucleic acid hypomethylating agent, is used in the treatment of myelodysplastic syndrome. Common adverse effects of azacitidine include bone marrow suppression, injection site reactions, nausea, vomiting, diarrhea, and fatigue. This report focuses on pleuropericardial effusions, an infrequently reported and potentially reversible adverse effect of azacitidine. In this case report, pleuropericardial effusion manifested as the sole radiographic finding in the evaluation of cough occurring during the eighth cycle of treatment with azacitidine. Symptoms and radiographic abnormalities resolved with corticosteroids and diuretics, and the patient could continue with therapy.
BACKGROUND: Myelodysplastic syndrome (MDS) is a heterogeneous group of hematopoietic stem cell disorders which is characterized by ineffective hematopoiesis and risk of progression into acute myeloid leukemia. The diagnosis and classification of MDS are determined from the findings of dysplasia in one or more cell lineage and the percentage of blast cell on bone marrow examination. However, it should be noted that an abnormality in one marrow cell lineage does not necessarily translate to the corresponding clinical phenotype. Here, we present a case of MDS with multilineage dysplasia (MLD) (erythrocyte, leukocyte, and thrombocyte) from bone marrow aspiration, but with anemia as the sole clinical manifestation (single cytopenia). CASE REPORT: A 78-year-old male patient came to our clinic on July 10, 2020, with chief complaint of worsening fatigue which started approximately 1 year before visit. His vital signs during the visit were stable and no other abnormalities observed other than pale conjunctivae. Complete blood count showed macrocytic anemia with no abnormalities in leukocyte count and thrombocyte count, which suggested a single cytopenia. Peripheral blood smear was negative for megaloblasts and hypersegmented neutrophils. The patient’s bone marrow examination showed MDS with MLD. This result was in contrast to complete blood count examination which only showed anemia (single cytopenia). CONCLUSION: This case showed that there could be discrepancy between clinical manifestations of the cytopenia with bone marrow dysplasia, which highlighted the importance of conducting bone marrow examination to properly classify MDS type.
Patients with myelodysplastic syndrome (MDS) require expert, consistent monitoring and management of their blood counts, disease status, and treatment regimens. Understanding how MDS presents and progresses as well as understanding treatment options and how to implement them on an individualized patient basis is essential for patients to receive optimal care. Nurse practitioners play a central role in the care of MDS patients. They have an opportunity to develop trusting relationships with their patients and are crucial parts of the health care team in helping to coordinate care, facilitate treatment, improve quality of life, and avoid life-threatening complications of the disease.
Chemotherapy-induced thrombocytopenia causes nearly two-thirds of cases of hrombocytopenia in the cancer setting In patients receiving chemotherapy thrombocytopenia leads to dose reductions in 15% of treatment cycles and chemotherapy delays in 6% of cycles In this issue of ONCOLOGY Dr Kuter insightfully summarizes the differential diagnosis and management of thrombocytopenia in cancer patients[1] Chemotherapy-induced thrombocytopenia causes nearly two-thirds of cases of hrombocytopenia in the cancer setting[2] In patients receiving chemotherapy thrombocytopenia leads to dose reductions in 15% of treatment cycles and chemotherapy delays in 6% of cycles © 2015, UBM Medica Healthcare Publications. All rights reserved.
