Written by Konstantinos Konstantopoulos Hematologist Director of MITERA Hematology Clinic
In hematology, there is a group of diseases with enough similarities between them, so that we consider them a special category, the so-called “myelodysplastic syndromes”. These, despite their individual differences, have some common points that characterize them as a “group”. They arise from a disorder of the proliferation and maturation of blood cells (white blood cells-red blood cells-platelets). As a result, the values in all or some of them are reduced in the blood test. Thus, we have reduced red (anemia) and/or white (leukopenia) and/or platelets (thrombocytopenia).
There are also certain abnormalities in the morphology of the blood cells, evident under microscopy to the experienced observer. The general impression today is that myelodysplastic syndromes occur more frequently than in the past. The reasons are many. The main one is the fact that they occur in older people who are slowly becoming the majority in the general population. Since the proportion of the elderly increases, so does the incidence of diseases of the elderly. So the frequency of myelodysplastic syndromes is also increasing compared to the frequency of the past. The main reason, however, is today’s increased “awareness” and “diagnostic readiness” of the medical professions as well as the general public, which leads to easier and earlier recognition of sufferers.
Furthermore, today blood tests are done much more frequently, much easier and with automated technology that allows early recognition of even the slightest deviation from normal values. Another reason for the increased frequency today in the statistics is the fact that in the past these diseases “circulated” and were recorded under various other names. That is, until a unified nomenclature was established for them towards the end of the 1960s. Previously there were various terms describing them, such as “pre-leukaemia”, “refractory anaemia”, “leukaemia of the elderly”, “subsequent leukemia” etc. With these terms, the old medicine described what today we call “myelodysplastic syndromes” (this does not mean that at that time they did not “put” other diseases in these categories).
The causes blamed for myelodysplastic syndromes are many and varied, but controlling and assigning a cause is difficult. The only sure cause is some antineoplastic drugs (cytostatics). However, most patients with myelodysplasia usually do not have a history of exposure to cytostatics. However, the preference for old age and some research data indicate that biologically myelodysplasia is probably a special “manifestation” of aging from the hematopoietic system parallel and analogous to the manifestations of aging from other organs and tissues such as the skin, hair, bones, eyes, endocrine glands, etc.
The diagnosis of myelodysplastic syndromes is made by the specialist doctor. It is always confirmed by studying the hematopoietic organ, i.e. the bone marrow (myelogram). Microscopy is usually indicative of the diagnosis, which is confirmed by “fine” studies of the hematological material, such as chromosomes and immunological testing, which also set the “stamp” of the diagnosis.
Treatment that completely restores the hematopoietic process of a person suffering from myelodysplastic syndrome does not exist. There is only an attempt to deal with it, not always completely successful and usually transient with means that aim to increase red blood cells (erythropoietin), white blood cells (growth factors) and platelets (thrombopoietins), as well as blood transfusions.
All these means have problems and difficulties. Any infections are treated with appropriate antibiotics. Newer treatments aimed at reversing myelodysplastic hematopoiesis are being tested but not yet standardized. A serious concern for the future of the patient is the possibility that the disease will develop into full-blown acute leukemia, in a serious proportion of cases, which perhaps justifies the older terminology of myelodysplasia as “proleukemia”. However, survival studies of patients show that the average life expectancy does not differ between those who develop and those who do not develop acute leukemia.
Aging is a phenomenon with many unknown aspects and secrets. Let’s not forget that there is no general agreement on the question “when does it start?” And this alone shows the difficulties of accurately understanding it, let alone treating it.
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