Overview
Myelodysplastic syndrome (MDS), also known as pre-leukemia syndrome, is a period of time when some cases of acute leukemia have symptoms, signs, blood and bone marrow abnormalities before diagnosis, but the diagnosis of leukemia cannot be confirmed, and pre-leukemia syndrome is of great significance to leukemia prevention and treatment and research.
Etiology
The cause of the disease is still unknown, but only some risk factors are found to induce the disease, such as ionizing radiation, strong electromagnetic field, the use of cytotoxic chemotherapeutic drugs, long-term exposure to organic solvents, heavy metals, pesticides, hair dyes and so on.
Symptoms
It is more common in middle-aged and old-aged people, and is more common in men than in women. Generally there are no obvious conscious symptoms, or only symptoms such as fatigue, weight loss, bleeding, skin petechiae, ecchymosis, pale skin and mucous membranes, hepatomegaly, splenomegaly, enlarged lymph nodes, and so on.
Examination
1. Bone marrow picture
(1) Most of them are actively proliferating, with normal or slightly increased prophylactic granulocytes, increased monocytes or young monocytes, and atypical mononuclear-like naive cells.
(2) The erythrocyte system is actively proliferating, and there may be megaloblastic changes, or ring-shaped iron granulocytic erythrocytes (iron staining).
(3) Megakaryocytes are increased and atypical. Smaller single nucleated, binucleated and multinucleated giant cells can be seen.
2. Blood picture
Decrease in whole blood cells, neutropenia or thrombocytopenia. There may be monocytosis, granulocyte nuclear foliation.
3. Bone marrow chromosome examination
It is a necessary test for the diagnosis of MDS, and the result can help to predict the efficacy and guide the treatment.
4. Second generation sequencing gene test
It is a necessary test for the diagnosis of MDS, and the result can help to predict the efficacy and guide the treatment.
Diagnosis
Diagnosis is made on the basis of clinical manifestations, results of bone marrow and blood tests, and exclusion of all other possibilities.
Treatment
1. Treatment is stratified according to different prognostic predictions.
2. For low to medium risk patients, symptomatic supportive therapy, such as erythropoietin and granulocyte colony-stimulating factor, is the mainstay of treatment.
3. Intermediate and high-risk patients should be treated aggressively. Allogeneic hematopoietic stem cell transplantation can be considered if available, and those who are not suitable for transplantation can opt for epigenetic therapy such as decitabine.
4. When transformed into acute leukemia, it should be treated according to leukemia.
5. Special types of patients are treated with specific drugs, such as lenalidomide for patients with 5q-syndrome.
Prognosis
Some patients die from acute leukemic transformation and some from bone marrow failure.
Prevention
Avoid some causative factors such as ionizing radiation, cytotoxic drugs, chemicals such as phosphorus, fluorine, benzene and carbon tetrachloride.
Nursing care
Strengthen nutrition, moderate exercise, avoid crowded places. Improve the resistance of the body.