Every morning we wake up to Robin Roberts on Good Morning America. Recently, while she has been brightening our mornings, she has also been dealing with a new health challenge, something called Myelodysplastic Syndrome or MDS. This is a rare blood disorder that affects the bone marrow and usually arises on its own. However, on occasion it can occur as a result of cancer treatment as it did as a result of Robin’s successful breast cancer treatment. For the past several weeks, at her request, I have been helping her to understand more about this condition and to connect to some of the leading experts across America.
MDS is a malignant disorder of the bone marrow. According to the NIH, approximately 18,000 people develop MDS each year but only several hundred of those are as a result of cancer treatment. MDS can affect all of the cells in our blood. As a result you can see problems related all of the blood components, red blood cells, white blood cells and platelets. Problems with the red blood cells show up as anemia or low blood counts. Problems with the white blood cells, a key part of our immune system, can lead to increased number and severity of infections. Problems with platelets, an important part of our clotting system, can lead to bruising. In addition to abnormal normal blood components, you can see immature cells called blasts. These cells are a harbinger of leukemia. In fact, MDS used to be called pre-leukemia due to the progression that is sometimes seen from MDS to leukemia. Sometimes this progression takes place quickly, sometimes not all.
The primary approach to treating MDS is a bone marrow transplant. The goal is to take bone marrow from a healthy donor and use it to replace and repair the abnormal bone marrow in the MDS patient. Oncologists use chemotherapy to eliminate all of the cells in the patient’s bone marrow and then infuse the new bone marrow. For this to work well, you need to have a bone marrow donor who has similar immune markers on their blood cells. The more closely matched the donor and recipient are, the more likely the immune system will not reject the new marrow and treatment will be successful. A perfect match is seen between identical twins. The next best thing is if there is a sibling with identical immune markers. In Robin’s case, she is quite fortunate; one of her sisters is an excellent match with identical immune markers.
Robin’s treatment begins today. She will be given a drug over the next few months to prepare her bone marrow for transplant. The side effects from this preparatory treatment should not be severe. She may feel a bit more tired than usual. Then, once her bone marrow is ready, she will undergo a bone marrow transplant. Her doctors can’t say exactly when this will take place, but probably sometime this fall. During that period, she will need to be away from work for a number of months while her bone marrow recovers.
Many patients with MDS are cured and go on to live long and productive lives. The good news is that her doctors expect Robin to be cured. She is young and incredibly healthy. Published statistics don’t shed much light on her prognosis as the vast majority of patients with this condition are diagnosed in their 70’s and 80’s. Robin has a donor who is an excellent match, an important prognostic factor. And so importantly, she has the faith, the spirit, and the will to beat this.
In addition to treatment, scientists know the intangible, unquantifiable importance of support -- friends and others -- in these situations. And in that way, Robin is blessed with family, close friends and supporters across the country and the world.