Myelodysplastic syndrome (MDS) is a class of malignant clonal diseases originating from hematopoietic stem cells, with clinical manifestations of anemia, hemorrhage, and fever, which can progress to acute leukemia, with poor treatment outcomes and lack of effective standard treatment protocols. For myelodysplastic syndromes in the low- to intermediate-risk group, our department has used high-dose recombinant human erythropoietin combined with granulocyte colony-stimulating factor, androgens and response arrest to achieve certain results.
Patient’s diagnosis: bone marrow cell morphology, bone marrow biopsy, karyotype analysis, MDS-FISH complete set, and routine blood and biochemical tests. Risk grouping was performed according to the patient’s blood, bone marrow cytomorphology, and genetics using the IPSS score system.
MDS typing
FAB typing Bone marrow Blast% Peripheral blood Blast% Other
RA <5 <1
RARS <5 <1 Bone marrow ringed iron granulocytes >15%
RAEB 5-20 <5< span="">
RAEB-t 21-30 >5
CMML 5-20 <5 Peripheral blood mononuclear cells >1000/ul
WHO typing Bone marrow Blast% Peripheral blood Other
RCUD(RA,RN,RT) <5, mono-lineage morbid one to two lineages reduced
RARS <5 anemia Bone marrow ringed iron granulocytes >15%
RCMD <5,< span=""> more than two lineages of disease Hemocytopenia
RAEB-1 5-9 blast 2-4% No Auer vesicles
RAEB-2 10-19 blast 5-19% May have Auer vesicles
5q- <5,< span="">Red lineage pathology only Anemia, plt may be elevated
MDS-U <5, genetic abnormalities Hemocytopenia
IPSS grouping of MDS
Score
Prognostic parameters 0 0.5 1.0 1.5 2.0
Bone marrow primitive cells (%) <5 5-10 ----- 11-20 21-30
Chromosomal karyotype Good Moderate Poor
Hematocrit 0-1 lineage 2-3 lineage
IPSS risk grouping (% IPSS population)
Low risk (33)
Intermediate-risk-1 (38)
Intermediate-risk-2 (22)
High risk (7)
Treatment goals for MDS in the low-risk group.
1. Reduce complications caused by anemia, low white blood cells, and low platelets.
2.Improve the survival quality of patients.
3.Delay or prevent leukemic transformation.
Treatment options.
1.Recombinant human erythropoietin 60-80,000 units/time, subcutaneous injection, once a week.
2. Combine with granulocyte colony-stimulating factor, response stop or lenalidomide, androgens, etc. if necessary.
3.Intermittent blood transfusion support therapy.
After clinical observation of the treated patients, the advantages of this treatment plan are summarized as follows.
1. Patients have good compliance and come to the outpatient clinic once a week for subcutaneous injection, which does not need to be injected daily or every other day as before. Moreover, the use of weekly high-dose injections can increase the peak blood concentration and achieve better efficacy.
2.No intolerance of patients was observed, and all patients reported no special discomfort.
3.Some patients who have completed about 2 months of treatment have achieved certain efficacy and prolonged transfusion interval.
4, The protocol refers to the literature of several well-known foreign journals, as well as domestic MDS diagnosis and treatment guidelines, with good safety.