Staging
Staging is a method that doctors use to determine the progression of cancer in a patient and the best course of treatment. The International Prognostic Scoring System (IPSS) is currently the primary system used to stage MDS. However, new classifications that take into account molecular and genetic signature are being tested. For the IPSS, doctors assign a risk level based on three main prognostic factors:
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Percentage of blasts in your bone marrow (scored 0, 0.5, 1.5, or 2.0)
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Chromosome abnormalities (scored 0, 0.5, or 1)
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Blood counts (scored 0 or 0.5)
Risk Level
Your doctor will assign a score for each of these prognostic factors. The higher the percentage of blasts in your bone marrow, the more chromosome abnormalities in your cells, and the more types of blood cells affected, the higher your score will be. Your doctor will then add these three scores together to determine your risk level:
- Low Risk (score of 0)
- Intermediate Risk 1 (score of 0.5 to 1)
- Intermediate Risk 2 (score of 1.5 to 2)
- High Risk (score of 2.5 or greater)
In addition to the IPSS, other models have been developed taking into account the molecular signatures of the disease and are being used to better differentiate the disease risk.
Treatment of Lower-Risk MDS
Lower-risk patients are usually treated initially to manage symptoms and complications such as anemia. Doctors may prescribe these patients medications or transfusions to improve blood counts. Hypomethylating agents (see below) may be considered if growth factors are not effective and patients remain transfusion dependent.
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Treatment of Higher-Risk MDS
Higher-risk patients usually need more aggressive treatment to try and reduce the risk of the disease transforming to acute leukemia, and to control the disease and improve survival. In certain situations, therapies such as high-dose chemotherapy followed by an allogeneic stem cell transplant may be ideal. A stem-cell transplant may be the initial treatment for younger, healthier patients, but older patients may benefit more from managing symptoms.
