Myelodysplastic Syndrome

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MYELODYSPLATIC SYNDROMS AFTER BONE MARROW TRANSPLANTATION


Background

Myelodysplastic syndrome (MDS) is the name given to a group of closely related diseases that arise in the bone marrow from hematopoietic stem cells. (Myelo refers to bone marrow and dysplasia means abnormal) (1). MDS can affect RBC, WBC, and platelets. Each year between 10,000 to 20,000 new cases of MDS are diagnosed in the United States, in patients with a median age of 70, although people of any age can develop the disease (2&3). The syndrome may develop de novo or secondary after treatment with chemotherapy and / or radiation therapy for other diseases. Secondary MDS accounts for about a quarter of the cases now diagnosed. Studies have suggested that treatment induced MDS is a frequent complication of potentially curative bone marrow transplant (3&4).
Hematopoietic stem cells are produced in the bone marrow and mature into functioning cells(1). MDS arises when one of these stem cells undergoes a transformation from a normal cell into a malignant cell, leading to uncontrollable proliferation. The malignant cell begins producing identical copies of it self, or clones; these clonal cells malfunction, in part, because different parts of the cell (the nucleus and the cytoplasm) mature at different rates (4). The dysplastic clones are incapable of maturing into functional adult cells, and over time the dysplastic cells may fill the bone marrow, and displacing the normal RBC, WBC, and platelets that are produced in the bone marrow(1). As the number of health cells decline, patients may be prone to life threatening conditions such as anemia, leukopena and Thrombocytopenia (4).
Case:
MJ is a 54 year old Hispanic male with a past medical history of Acute Myeloid Leukemia status post autologous Bone marrow transplant, at Georgetown University Hospital Lombardi Comprehensive Cancer Center in 2002, presented to Howard University Hospital with a chief complain of Sho...