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by Polsdorfer R

Here are the basics about each of the medicines below. Only the most common reactions are listed. Ask your doctor if you need to take any special steps. Use each of these drugs as advised by your doctor or the booklet they came with. If you have any questions, call your doctor.

Medicine may help ease or prevent side effects of treatment, or to control certain side effects once they happen. These effects can happen from MDS or its treatment:

Antibiotics

Common names:

  • Cefepime
  • Piperacillin-tazobactum
  • Vancomycin
  • Amoxicillin-clavulanate

MDS that reduces white blood cell counts cause immune system problems. This increases the risk of infections. Most infections affect the lungs or skin.

Possible problems are:

Blood Stem Cell Support Drugs

Common names:

  • Filgrastim (white blood cells)
  • Sargramostim (white blood cells)
  • Epoetin (red blood cells)
  • Darbepoetin alfa (red blood cells)
  • Oprelvekin (platelets)

These drugs help the bone marrow make new blood cells. White blood cells will lower the risk of infection. Red blood cells lower the risk of anemia. Platelets lower the risk of bleeding. These medicines are used with chemotherapy.

Some problems with filgrastim are:

  • Headache
  • Pain in arms or legs
  • Pain in joints or muscles
  • Pain in lower back or pelvis
  • Skin rash or itching

Some problems with epoetin are:

  • Cough, sneezing, or sore throat
  • Fever
  • Swelling of face, fingers, ankles, feet, or lower legs
  • Weight gain
  • High blood pressure (not common)

Some problems with oprelvekin are:

  • Rash
  • Nausea
  • Thrush
  • Breathing problems
  • Light-headedness
  • Feeling tired
  • Headache
  • Blurry vision

Blood Transfusions

MDS depletes the numbers of red and white blood cells and platelets. Blood transfusions are a way to replace cells and healthy blood cell counts. Blood is given through an IV. The blood comes from a donor. Donated blood must match your blood type. The donor and recipient blood is tested for type. But you will be watched during the transfusion for any reactions.

Blood transfusions do not offer a cure, but they do help ease symptoms. It is common to need more than 1 transfusion.

Some problems are:

  • Transfusion reaction—The immune system sees the donor blood as foreign and attacks the cells. The risk of this goes up with each transfusion.
  • Hemochromatosis—Excess iron in the blood settles in the skin, liver, heart, or pancreas and leads to organ damage.
  • Infection.

Hypomethylating Agents

Capecitabine and azacytidine work on genes to slow cell growth and kill cancer cells. They are used to treat certain types of MDS and acute myeloid leukemia. These drugs are given through an IV in cycles.

Some problems are:

  • Harm to an unborn baby—Women should not become pregnant while being treated with decitabine. Men should not father a child while receiving decitabine and for 2 months after treatment ends.
  • Anemia
  • Low white blood cell count
  • Low platelet count
  • Nausea or vomiting
  • Light-headedness
  • Constipation
  • Feeling tired
  • Fever
  • Rash or itching

Immunotherapy

Immunotherapy is used to modify, enhance, or suppress the immune system. Thalidomide and lenalidomide are used to treat people with a certain type of MDS. These drugs increase red blood cell counts and help with bone marrow function. Thalidomide and lenalidomide are taken by mouth.

Some problems are:

  • Severe, life-threatening birth defects or death of an unborn baby—Women must not get pregnant 4 weeks before treatment, use the drugs during pregnancy, and must not take it 4 weeks after pregnancy.
  • Low white blood cell count
  • Low platelet count
  • Blood clots
  • Diarrhea
  • Itching
  • Rash
  • Feeling tired

Antithymocyte globulin (ATG) and cyclosporine have been useful in treating some people with MDS, especially ones who are younger. The drugs suppress how the body reacts to certain white blood cells.

Some problems with ATG are:

  • Serious allergic reaction
  • Low blood pressure
  • Trouble breathing
  • Fever
  • Headache
  • Belly pain
  • Muscle aches
  • Nausea
  • Diarrhea

Some problems with cyclosporine are:

  • Headache
  • Fever
  • Nausea or vomiting
  • Higher than normal blood pressure
  • Hair growth
  • Gum enlargement
  • Numbness or tingling

General Information about Medicine

When taking any medicine:

  • Take medicine as directed. Do not change the amount or the schedule.
  • Be aware of the side effects of your medicine. Tell your doctor if you have any.
  • Talk to your doctor before you stop taking any prescription medicine.
  • Medicine can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one medicine. This includes over-the-counter products and supplements.
  • Plan for refills as needed.

References

Azacitidine. EBSCO DynaMed website. Available at:  https://www.dynamed.com/drug-monograph/azacitidine . Accessed October 3, 2020.

Decitabine. EBSCO DynaMed website. Available at:  https://www.dynamed.com/drug-monograph/decitabine . Accessed October 3, 2020.

Myelodysplastic syndrome. EBSCO DynaMed website. Available at:  https://www.dynamed.com/condition/myelodysplastic-syndrome-mds . Accessed October 3, 2020.

Treating myelodysplastic syndromes. American Cancer Society website. Available at: https://www.cancer.org/cancer/myelodysplastic-syndrome/treating.html. Accessed October 3, 2020.

Treatment option overview. National Cancer Institute website. Available at: https://www.cancer.gov/types/myeloproliferative/patient/myelodysplastic-treatment-pdq#section/%5F49. Accessed October 3, 2020.

Revision Information

  • Reviewer: EBSCO Medical Review Board Mohei Abouzied, MD, FACP
  • Review Date: 09/2020
  • Update Date: 10/02/2020