Supportive Care of Myelodysplastic Syndromes: Blood Cell Growth Factors

This content has been reviewed and approved by

Hagop M. Kantarjian, MD
Chairman & Professor, Leukemia Department
MD Anderson Cancer Center
University of Texas

Although patients may not initially experience symptoms, the ineffective blood cell production that characterizes myelodysplastic syndromes (MDS) eventually results in uncomfortable and life-threatening side effects. Low red blood cell production results in anemia and associated fatigue; low white blood cell production causes neutropenia, which increases the risk of infection; and low platelets causes thrombocytopenia and an increased risk of bleeding. 

Patients who are at low-risk of progressing to AML may not have any of these symptoms or they may require supportive treatments to prevent the complications associated with low blood counts. Several strategies exist for improving blood cell production and decreasing complications. 

Anemia - Patients who are not producing enough red blood cells are anemic and may experience fatigue, difficulty conducting normal activities or tasks, and/or worsening of heart and lung problems, depending on the severity of their anemia. 

Anemia can be treated with a red blood cell transfusion or by increasing red blood cell production with a naturally produced protein called erythropoietin. Erythropoietin stimulates the bone marrow to produce more red blood cells. 

When administered to some patients, it reduces the severity of anemia and can prevent red blood cell transfusions. 

Currently, there are two forms of erythropoietin available: Epogen^® or Procrit^® (epoetin alfa) and Aranesp^® (darbepoetin alfa). Darbepoetin alfa is a longer acting form that can be administered less frequently. Both can improve transfusion dependence in 30 percent to 50 percent of patients and improve quality of life. These favorable responses are also lasting, averaging 2.5 years. 

Neutropenia - Neutropenia, or a low white blood count, increases a patient's risk of infection. The white blood count can be temporarily increased with Neupogen^® (filgrastim), which stimulates the growth and production of white blood cells. This can decrease the chance of additional or worsening infections.  

Thrombocytopenia - Thrombocytopenia, or low platelet counts, increases a patient's risk of bleeding.