Ask the expert

Dr. Shaal Patel, a board certified physician in hematology, oncology, and internal medicine, spoke with Healthline about how myelodysplastic syndromes (MDS) can benefit from supportive therapy, including the options available, how it fits into the overall treatment plan, and how it may affect survival and other outcomes.

Supportive therapies in MDS means treatments that help with the complications of the disease rather than treating the disease itself. For example, many people who get sick from the influenza (flu) virus choose supportive treatments rather than treating the virus itself, as the virus resolves on its own.

The medications that are considered supportive therapies for the flu that people may be familiar with are acetaminophen (for fever and body aches), Vicks vapor rub (for nasal congestion), and Mucinex or Robitussin for helping with a cough.

These supportive medications do not treat the actual influenza virus itself but rather give the patient comfort from the symptoms until the body fights off the virus and the symptoms resolve.

In MDS, the body doesn’t fight off MDS by itself. But there are supportive therapies in MDS to help reduce the chance that patients get symptoms from one of the complications from MDS, including transfusion of blood products, treatments to reduce the iron buildup in the blood from multiple transfusions, and antibiotics.

Supportive therapies in MDS include:

  • Blood transfusions: These can be done to increase either red blood cells (to treat anemia) or platelets (to help prevent bleeding).
  • Blood growth factors: Erythropoietin (EPO) is a hormone in the blood that naturally helps stimulate red blood cell production from the bone marrow when it is needed by the body. EPO-stimulating agents (ESA) are medications that mimic these effects to help stimulate the production of red blood cells since people with MDS can be anemic (i.e., have a low number of red blood cells). Growth factor for white blood cells isn’t used in MDS because it can cause the MDS to become more aggressive and turn into leukemia.
  • Iron chelating agents: The number of red blood transfusions can pile up, and this leads to an excess amount of iron in the body that can deposit in the organs and cause dysfunction. Iron chelating agents help reduce the amount of iron buildup in the body if it is a problem.
  • Antifibrinolytic agents (e.g., aminocaproic acid): These agents help when bleeding does not respond to platelet transfusions.
  • Antibiotics: These are useful in both preventing infections when a person’s white blood cell count is low or treating infections that people with MDS may have a difficult time clearing with their own immune system.

Without supportive treatments, people with MDS would succumb to the disease much sooner than expected due to severe anemia.

Anemia can result in fatigue or shortness of breath, lightheadedness, bleeding from low platelet counts, or life threatening infections from low or dysfunctional white blood cells.

Supportive therapy is essential in the MDS treatment plan because both the disease and the treatment itself can cause complications of anemia, bleeding, or increase the chance of having an infection.

The goals of supportive treatments are to minimize the complications from either MDS itself or the treatment.

Symptoms of fatigue, shortness of breath, lightheadedness, weakness, bleeding, easy bruising, and frequent or prolonged infections can all be improved with these supportive therapies.

The quality of life for people with MDS improves with supportive treatments.

MDS comes in different forms of aggressiveness, and sometimes supportive therapy is more appropriate than the actual treatment for the disease. It is best discussed with a person’s oncologist as to what the ideal options are based on risk level.

Supportive therapy aims to improve the outcome of a person’s symptoms in MDS. It will often assist in reducing a person’s symptoms, which then makes them more comfortable.

When looking at previous trials, there is no strong data that points showing whether using supportive therapies alone versus MDS treatments is beneficial to a person’s overall survival.

Generally, if a person has a choice between not taking all supportive therapies for MDS while having a complication (severe anemia, infection, bleeding, etc.) versus accepting a supportive therapy to help treat the complication, they will most likely live longer if they accept the supportive therapy to help treat their complications of MDS.

Dr. Sheel Patel is an ABMS board certified physician in hematology, oncology, and internal medicine. Dr. Patel is a practicing physician at the Orlando VA Medical Center in Florida. He specializes in genitourinary oncology.