Complications
Liver and other organ abnormalities can result from haemochromatosis secondary to multiple transfusions.[95] This may develop over an extended period of time, depending on the frequency of blood transfusions, but may be prevented by the use of iron chelation therapy.
Patients who require regular transfusion should be assessed for iron chelation therapy. Iron chelation therapy can improve event-free survival and should be considered for patients with a favourable prognosis with high transfusion burden (e.g., 15 or more RBC transfusions); serum ferritin levels exceeding 1000 micrograms/L on repeat measurements.[12][15][16][96] Candidates for allogeneic stem cell transplantation should receive early chelation therapy.[16]
Neutropenia and neutrophil dysfunction predispose to recurrent infections. Bacterial infections are the principal cause of death in patients with MDS.[5] Treatment is broad-spectrum antibiotics when these patients are febrile.
Growth factor support with granulocyte-colony stimulating factor (G-CSF; e.g., filgrastim) may improve neutrophil counts but does not improve long-term survival. G-CSF may be considered in patients with recurrent infections, but is not routinely recommended (including for infection prophylaxis).[15]
Bleeding complications are possible due to thrombocytopenia and functional defects of platelets. Platelet transfusion may be considered if there is bleeding, or if platelet count is less than 10×10⁹/L, or before planned procedures (e.g., if platelet count is less than 50×10⁹/L before major surgery).[94]
Once patients develop ≥20% undifferentiated blasts in the bone marrow, they are considered to have progressed to acute myeloid leukaemia (AML).[65] AML arising from MDS is usually refractory to standard therapy for MDS. Patients with secondary AML who are treated with chemotherapy regimens used for de novo AML may achieve remission but usually relapse quickly; allogeneic stem cell transplantation is recommended in eligible patients.
Clinical trial enrolment is appropriate if a patient with secondary AML wishes treatment and can tolerate therapy.
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