Prognosis & Disease Evolution
Return to Q&A Library What To Expect When Illness Progresses
Remission and Stem Cell Harvest
Risks of Aplastic Anemia Developing Into MDS
Reversing Chromosome Damage
MDS Progressing to Leukemia
Liver Problems Associated with Diseases
Iron Supplements
Spleen Removal in MDS
What To Expect When Illness Progresses
What can patients and family members expect when the illness progresses to the end-stages of a patient's life?
Patients and family members should express their concerns and direct their questions to their doctor because each case is unique. Also, contact our Patient Information Department at the Aplastic Anemia & MDS International Foundation who will discuss these issues and can put you in touch with other family members who will share their experiences. Call our toll-free help line at 800.747.2820 or help@aamds.org.
Remission and Stem Cell Harvest
How do you define "remission" for a patient with aplastic anemia in terms of being able to harvest stem cells?
Remission means normal blood counts and normal numbers and functions of Cells in the body that develop into other cells. There are two main sources of stem cells. Embryonic stem cells come from human embryos and are used in medical research. Adult stem cells in the body repair and maintain the organ or tissue in which they are found. Blood-forming (hemapoietic) stem cells are found in the bone marrow. These cells make copies of themselves and develop into red cells, white cells, and platelets.
stem cells. Many people believe that (in most persons) stem cells never return to normal in both numbers and functions. Therefore, harvesting one's own stem cells as "insurance" would be considered investigational.
Risks of Aplastic Anemia Developing Into MDS
What percentage of aplastic anemia develops into MDS?
It varies from among studies with the original treatment and follow-up. In some studies, 35-50% of patients who are followed for 10-20 years have developed MDS or AML. In other studies, the frequency of these complications is less than half of these numbers.
Reversing Chromosome Damage
Do damaged chromosomes reverse themselves after successfully being treated with medical therapy for MDS?
The chromosome changes may "disappear" in a patient who enters remission with medical therapy. This is probably not a cure but just a decrease in the level of abnormal cells to levels that are not detectable by standard methods. With transplantation, there may be true eradication of cells with abnormal chromosomes.
MDS Progressing to Leukemia
Does ATG treatment for MDS have anything to do with development of leukemia or does MDS progress to leukemia in some patients?
The published studies of ATG is an immunosuppressant, a drug that lowers the body's immune response. Scientists believe that aplastic anemia happens when the immune system attacks and destroys bone marrow stem cells. ATG kills the specific cells that are attacking the bone marrow stem cells. This allows the bone marrow to grow and make new blood cells. ATG may be used to treat other bone marrow failure diseases in some cases. ATG is approved by the U.S. Food and Drug Administration (FDA) for treating moderate and severe aplastic anemia. ATG is commonly used with another drug called cyclosporine.
anti-thymocyte globulin(ATG) administration in myelodysplastic syndromes (MDS) patients have not reported an increased risk of disease progression.
The majority of case of MDS will not turn into acute leukemia. The risk factors present at the time of MDS diagnosis can predict the disease course in many patients. Those MDS patients with a high risk of developing AML (based on the percentage of bone marrow A young white blood cell. The number of blast cells in the bone marrow helps define how severe MDS is in a person. When 20 out of 100 cells in the bone marrow are blasts, this is considered acute myeloid leukemia.
blasts and the types of chromosome abnormalities present) probably will not benefit from ATG administration.
Liver Problems Associated with Diseases
Are problems with the liver or kidney function frequently associated with aplastic anemia and myelodysplastic syndromes?
Though liver or kidney problems are not typically caused by aplastic anemia or MDS, they can occur in patients for many reasons. Disease-related reasons could include iron overload from multiple blood transufions (liver) or infection or medication (e.g. ara-C can cause hepatoxicity). Liver or kidney injury can result from An immunosuppressant, this drug that lowers the body's immune response. Cyclosporine is used along with antithymocyte globulin (ATG), another immunosuppressant, for treating aplastic anemia and some other forms of bone marrow failure.
cyclosporine, but these effects are at least partially reversible by dose adjustment. Most often, liver or kidney problems are un-related to the diseases and have to do with underlying disease conditions.
Iron Supplements
If a person was receiving oral iron supplements for anemia for several years before diagnosis of pure red cell aplasia, could supplemental iron contribute to bone marrow damage or other organ damage?
Doses of iron that are used in typical "tonics" do not contain enough iron to cause problems unless the patient has an inherited or acquired problem with iron absorption (hA condition that occurs when the body absorbs and stores too much iron. This leads to a condition called iiron overload. In the United States, hemochromatosis is usually caused by a genetic disorder. Organ damage can occur if iron overload is not treated.
emochromatosis) or The most numerous type of blood cell in healthy people. Red blood cells contain hemoglobin, a protein that picks up oxygen in the lungs and brings it to cells in all parts of the body. Also called erythrocyte, RBC.
red blood cells production (aplastic anemia, pure red cell aplasia). Once one of these problems is diagnosed then supplemental iron would be contraindicated.
Spleen Removal in MDS
When and why would spleen removal be recommended in MDS? What are the general risks and benefits of splenectomy in MDS?
In some subtypes of myelodysplastic syndromes (MDS), such as chronic myelomonocytic leukemia (CMML), the spleen can become very large. When it reaches 20 to 25 cm in length, it can cause reductions in peripheral blood counts. At that point, low dose radiation and/or removal of the spleen may be indicated, especially if it has become large enough to cause vascular problems.
Splenectomy is generally well tolerated in experienced hands, but requires preparation (respiratory exercise) and approximately a month of recovery time.
