Myelodysplastic Syndrome World Awareness Day
Grupo Biotoscana interviews Dr. Breno Moreno de Gusmão.
Montevideo, Uruguay, October 25, 2018. To celebrate the Myelodysplastic Syndrome Awareness Day, GBT Grupo Biotoscana interviewed Dr. Breno Moreno de Gusmão, hematologist at Beneficência Portuguesa de São Paulo. Dr. Breno is also Hematology Coordinator at Hospital Santa Lucia – Brazil, member of the Spanish Myelodysplasia Group and secretary and founding member of the Latin American Myelodysplasia Group. He holds a medical degree from the Universidad Complutense de Madrid and specialist in Hematology by the Hospital San Pedro – La Rioja.
GBT: What is Myelodysplastic Syndrome, better known as MDS, and what are its main symptoms?
Dr. Breno: Myelodysplastic syndrome refers to a heterogeneous group of hematopoietic (blood-forming) clonal diseases of the bone marrow, where hematopoietic (blood formation) deficiency is frequently observed. The three cell lines of the bone marrow (white series, red series and platelet series) are diminished and/or dysfunctional with tendencies to anemia, infections and bleeding. There is a high risk of this condition turning into acute myeloid leukemia. Therefore, the main symptoms are due to the lack or dysfunction of red blood cells causing anemia, white blood cells, becoming susceptible to infections and by platelet deficiency or dysfunction, being susceptible to hematomas and/or hemorrhages.
GBT: Is there any consensus on the causes of MDS and is there any kind of prevention?
Dr. Breno: In most cases it is not possible to identify an external antecedent cause. The use of DNA-damaging drugs (chemotherapy), used to treat different types of cancer, increases the risk for myelodysplasia. There is a certain predominance of the condition in patients who have been exposed to chemo or radiotherapy and in those exposed to hydrocarbons (such as workers in petroleum industries, pesticides) and there are some studies that relate cigarette smoking to myelodysplasia.
GBT: How is the disease diagnosed?
Dr. Breno: The diagnosis of MDS begins with the clinical suspicion of a patient presenting symptoms related to the lack/changes in the blood tests. For the diagnosis, it is essential the medullary study, where we will evaluate the bone marrow, the organ responsible for the production of blood cells. In MDS, we see morphological changes and we will search through specific genetic studies associated with MDS. The sum of specific changes in the diagnosis informs us of the severity of the condition.
GBT: Does Brazil now offer broad access to these diagnostic methods?
Dr. Breno: Unfortunately, in Brazil there is not a wide access to the procedures and techniques for the diagnosis of MDS, mainly in the scope of public health. Because of this lack of diagnostic methods, many patients are diagnosed in advanced stages of MDS, some of which have already progressed to acute leukemia.
GBT: Is it a condition that affects the quality of life of patients? What is the risk of not initiating the appropriate treatment promptly?
Dr. Breno: It certainly affects the quality of life. In MDS we have two objectives: (1) when we diagnose in the initial phase, our objective is to correct the lack of cells (anemia, thrombocytopenia, neutropenia) and thus avoid the consequences resulting from this deficiency; (2) the diagnosis in the advanced stage is a more serious stage. It is a situation where the disease is turning into leukemia and we have to deal with it to improve the patient‘s survival.
GBT: What is the role of hypomethylating agents in the treatment of MDS?
Dr. Breno: Hypomethylating agents are drugs that act at the genetic and epigenetic levels, correcting the manufacture of cells in the bone marrow (hematopoiesis). It is the treatment suitable for more advanced situations of the disease, where it acts by modifying the patients‘ survival.
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