Welcome to the twenty third part of a series on Hemato-oncology.
Question: Dr. Chiragbhai, thank you for explaining us re CLL. It was interesting to note that now we can decide therapy based on cytogenetics. Also, that a number of CLL patients can be left untreated for long time, a large number can be treated with very mild treatment options, at the same time, there are some who need upfront very intensive treatments like allogeneic stem cell transplant.
What is the next disease that you are going to tell us about?
Answer: Well, the next disease is MDS or Myelodysplastic Syndrome. MDS is also a disease with large variations in clinical course, treatment options and prognosis. It is easier to say that it is not one disease, but a number of different diseases with some similarity. Also, it is one of the most difficult diagnosis to suspect, and frequently difficult to even confirm the diagnosis.
Que: Ok. But in this series we have been mostly talking about malignancies. Why are we now discussing a benign blood disorder?
Ans: Good question. But MDS or Myelodysplastic Syndrome is not a benign blood disease. It is also a hematological malignancy, just like CLL, CML, AML etc. This is also a disease arising from an abnormal clone of cells, the hallmark of malignancy. And there is overall about 25% chance of MDS going into Acute Myeloid Leukemia. That is why it is also known as “preleukemic condition”.
Que: This is really a new knowledge for me. MDS seems to be on rise. What is the reason for that and when do you suspect it?
Ans: MDS does seem to be rising. However, like most other malignancies we have very little authentic data in India. Etiology is not clearly known, but is suspected to be due to exposure to various chemicals. Rarely, it is related to past therapies, such as certain chemotherapy medicines or radiotherapy. MDS is suspected in following situations:
- Anemia – especially with normal to high MCV, when other common diseases are ruled out. One type of MDS i.e. RARS often has low MCV and should be considered in differential diagnosis of suspected iron deficiency anemia that is not improving with iron supplement.
- Thrombocytopenia – infrequently presents with only low platelet. But should be considered when other common causes are ruled out or is refractory.
- Leucopenia – rarely presents as isolated leucopenia.
- Pancytopenia – two or more cell lines affected e.g. low Hb and low platelet or all three counts low. Commonest presentation.
- AML –few patients present late when it has already progressed to acute leukemia.
Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA), 98243 12144, 98988 31496
Diplomate American Board of Oncology and Hematology. Ahmedabad. firstname.lastname@example.org
Shyam Hem-Onc Clinic. 402 Galaxy, Near Shivranjani, Opp Jhansi ki Rani BRTS, Ahmedabad. www.shyamhemoncclinic.com