Patients with MDS and bone marrow failure with declining blood counts are candidates for transfusion therapy with red blood cells, platelets, or both. Blood transfusions are by far the most beneficial form of supportive care and are essential to improve quality of life and survival [1]. Due to disease progression, approximately 80-90% of MDS patients will receive a blood transfusion at some point in their life. The aim of transfusion therapy is primarily focused on alleviating symptoms, although in some low-risk types of MDS such as RA, transfusion therapy can improve patient survival [2]. However, regular transfusion therapy can have a negative impact on quality of life, or lead to an increased risk of infection or the development of iron overload.

Prior to establishing a treatment regimen, the type of MDS disease must be considered (according to WHO guidelines [2]), as well as severity and likelihood of mortality. The actual criteria used to decide whether an MDS patient will undergo transfusion and subsequent chelation therapy varies between different regions [3]. Chelation therapy is generally most suitable for patients with significant transfusion dependency and good-life expectancy. With a poorer prognosis or shorter life expectancy, iron overload-related complications may not have time to develop. The decision can be aided by employing the International Prognostic Scoring System risk score [4], which takes into account cytogenetic, morphologic, and clinical data. A patient with a higher score (e.g. 12-18) is likely to have a more stable disease and hence require chelation therapy, whereas with lower scores, the poor prognosis may not necessitate this.

The main goal is to improve the oxygen-carrying capacity of the blood as a measure to improve quality of life. Treatment may also include hemopoietic growth factors such as erythropoietin [5] and/or granulocyte colony-stimulating factor [6].

PRACTICAL STEPS FOR TRANSFUSING PATIENTS WITH MDS

The care of patients with MDS is constantly changing due to the recent introduction of new drug therapies. At present, blood transfusion represents perhaps the most important supportive care that can be provided for these patients. Current practices to optimize transfusion therapy include:

• The use of leukocyte-depleted blood products, which have been shown to decrease non-hemolytic febrile reactions, reduce alloimmunization, and platelet refractoriness [7].
• Considering iron chelation therapy for patients who have received chronic or repeated red blood cell transfusions.

References
(1) Hellstrom-Lindberg E: Management of anemia associated with myelodysplastic syndrome. Semin Hematol 2005; 42(2 Suppl 1):S10-S13. (2) Vardiman JW, Harris NL, Brunning RD: The World Health Organization (WHO) classification of the myeloid neoplasms. Blood 2002; 100(7):2292-2302. (3) Gattermann N, Porter J, Lopes LF, Seymour J: Consensus statement on iron overload in myelodysplastic syndromes. Hematol Oncol Clin North Am 2005; 19(Suppl. 1):18-25. (4) Greenberg P, Cox C, LeBeau MM, Fenaux P, Morel P, Sanz G, Sanz M, Vallespi T, Hamblin T, Oscier D, Ohyashiki K, Toyama K, Aul C, Mufti G, Bennett J: International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood 1997; 89(6):2079-2088.
(5) Adamson JW: The promise of recombinant human erythropoietin. Semin Hematol 1989; 26(2 Suppl 2):5-8. (6) Zecca M, Perotti C, Marradi P, Montagna D, Giorgiani G, Balter R, Prete L, Locatelli F: Recombinant human G-CSF-mobilized peripheral blood stem cells for second allogeneic transplant after bone marrow graft rejection in children. Br J Haematol 1996; 92(2):432-434. (7) Baranowski L: Filtering out the confusion about leukocyte-poor blood components. J Intraven Nurs 1991; 14(5):298-306.

Learn about the benefits of chelation therapy in treating transfusional iron overload.