Is MDS that returns after treatment(s) have successfully controlled it considered recurrent MDS?
worsening blood counts, and worsening bone marrow studies, that is recurrent MDS. Recurrent MDS can happen after supportive approaches, after medical treatments, and even after an allogeneic stem cell transplant. So, I think of recurrent MDS to mean progression or re-emergence of MDS after a period of remission or managed stability.
Is the frequency of recurrent MDS known, and is a certain type of patient more likely to experience it?
To date, this has not been well studied, but what we do understand is that the large majority of patients with MDS who have periods of disease stability or respond to treatments will eventually recur. Most supportive care or active medical treatments are more temporary treatments and are not permanent or curative.
Is it known why recurrent MDS happens?
for awhile, it is possible that the responding MDS will obtain additional genetic events that render it resistant to the very same treatment. There are certainly many groups working on understanding the development of mutations in hopes of finding better treatments.
Is anything done differently when it comes to treating a recurrent case of MDS?
MDS, like all blood and bone marrow cancers, can go into remission and then recur. Once bone marrow and blood cancers recur, we don’t think of them as being curable by medical treatments. So when patients have recurrent or progressive MDS, we often explore the possibility of whether
an allogeneic stem cell transplant might be something appropriate for them. Not all patients are good candidates for a stem cell transplant, but many are.
If stem cell transplantation is the only cure for MDS, does that mean recurrent MDS cannot occur in someone who undergone a transplant and no longer has MDS symptoms?
It needs to be stressed that an allogeneic stem cell transplant is not a guaranteed cure. Not all transplants are successful. So, in fact, many patients will have recurrent MDS following a stem cell transplant. Efforts continue to try to lower the chance of MDS returning after a stem cell transplant, but still somewhere between one third and one half of patients will eventually have their MDS return even after a potentially curative stem cell transplantation. So stem cell transplants aren’t the answer for all patients or all types of MDS.
What do patients who are post-treatment most need to know about recurrent MDS? Is there anything they can do to lessen the chances of this occurring?
MDS. Also, they should take the necessary steps improve and maintain their overall health. This means plenty of rest, staying physically active, and working towards a balanced and healthy diet. What we’ve found through the years is that patients who are in good overall physical health tend
to better tolerate different treatments. It is also important to maintain a very active dialog with your physician and treatment team to help manage the disease and to build a solid understanding of what is going on with your body and bone marrow so you are ready to face any changes in your bone marrow that may occur post-treatment.
What is the difference between de novo MDS and secondary MDS?
The second defi nition relates to the MDS being related to previous cancer therapies, including chemotherapy and radiation therapy. So the language we use to describe the secondary MDS types has evolved over time into the “therapy-related MDS” and “MDS arising from or associated with another primary bone marrow disorder.” People tend to hear a bit more about the therapy-related MDS.
By what degree is secondary MDS less frequently seen than de novo MDS?
What are the known risk factors for developing de novo secondary MDS?
- acute myeloid leukemia (AML)
- myelodysplastic syndromes (MDS)
- myeloproliferative neoplasms (MPN)
B. Douglas Smith is Professor of Oncology at Johns Hopkins University School of Medicine in Baltimore, Maryland, and is on the active staff of Johns Hopkins Hospital. He earned his medical degree at the Medical College of Pennsylvania in Philadelphia, after which he completed an internship, residency, and chief residency at Strong Memorial Hospital in Rochester, New York. At the completion of his fellowship in Oncology at Johns Hopkins University, he joined the faculty in the Division of Hematologic Malignancies.
Dr. Smith’s research focuses on taking new and promising laboratory insights and developing them into biology-based treatment approaches for patients with AML, CML, and MDS. He has developed collaborations with several laboratory-based physician-scientists and has help to translate differentiation-based strategies, small molecule inhibitors of signal transduction pathways (including, FLT3 mutated AML, raf kinase, ras kinase, and bcr-abl), and immunomodulatory approaches. Many of these trials share the common theme on studying the impact of the treatment on the leukemic stem cell in hopes of limiting these cells’ roles in treatment failure.
Dr. Smith serves on the NCCN Guideline panels for both AML and CML and as guest editor for numerous journals including Journal of Clincal Oncology, Leukemia, Clinical Cancer Research, Leukemia Research, and others. In addition, he is an active member of American Society of Hematology, the American Society of Clinical Oncology, and the American Association for Cancer Research.
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