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    Suggest treatment for myelodysplasia

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Posted on Sat, 24 Jun 2017 in Blood Disorders
Question: I have been diagnosed with the following: hypothyroidism (2002), membranous nephropathy (2013) (glomerulonephritis and proteinuria), gout (2015), a DVT (9/16), myelodysplasia (12/16) (refractory cytopenia with multilineage dysplasia) (Aranesp injections did not help and were discontinued after 4), weight loss of 35 pounds in 6 months, drenching night sweats, low grade fevers several days a week (usually starting in the early evening), itchy skin rashes that come and go, migrating arthralgias, a dry cough, and worsening hoarseness. I have been to many doctors and had many tests/scans and tons of blood work and nothing is coming up that ties all this together. On blood work, the following are always elevated: WBC, erythrocyte sedimentation rate, C-reactive protein, BUN, Rheumatoid Factor, Haptoglobin, and Neutrophils (# & %). Always low on blood work: RBC, hemoglobin, hematocrit, and Lymphocytes. I know, it's complicated, but, any thoughts for next steps?
doctor
Answered by Dr. Deepak Sundriyal 2 hours later
Brief Answer:
There are several options

Detailed Answer:
Hello dear. I have gone through the details.

So in a case of myelodysplasia, there are several options. Before discussing any treatment options you will require risk stratification of your illness in either high risk or low risk and then treatment can be charted out accordingly.

Treatment includes Erythropoietin, lenalidomide immunomodulator, blood transfusion, chemotherapy or marrow transplant.

You must discuss these options with your doctor as it will certainly lead to increasing in survival and quality of life.

Thanks and regards
Feel free to ask further


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Deepak Sundriyal 47 hours later
Thank you, doctor.

First of all, do you feel that all of my symptoms would fall under my myelodysplasia diagnosis (including the fevers, drenching night sweats, rashes, elevated WBC and inflammation factors, etc.), or are they separate issues? There seems to be an autoimmune issue, correct? Is that part of the myelodysplasia?

How do I go about getting a 'risk stratification' for my myelodysplasia?

My hematologist has tried erythropoietin shots and they have not helped. Would a next step be the lenalidomide immunomodulator? Is that a typical 'next step' after erythropoietin? Is that a new treatment, as I haven't heard of it from my local hematologist? Would a hematologist provide that?

Thank you.
doctor
Answered by Dr. Deepak Sundriyal 2 hours later
Brief Answer:
Hello. All depends on your risk score

Detailed Answer:
Hello dear. So your risk score will depend upon your hemoglobin, neuterophil count platelet count, blast cells and cytogenetics. Depending upon that a treatment can be planned and yes, very well you can be a candidate for lenalidomide drug.
Fever and rash can be seen in. Myelodysplasia. Your hematologist can calculate risk score for you and plan a treatment. Its not a new treatment but a tested older one.
Thanks and regards.
Feel free to ask further
Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. Deepak Sundriyal

Oncologist

Practicing since :2005

Answered : 1546 Questions

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