Q: I am a 64 years old male weighing 60 kg. I am unable to walk properly and have a breathing problem also. I was diagnosed with myelodysplastic syndrome. Three Decogen (50 mg) injections were given. My haemoglobin level was 3.6 g/dl and bone marrow showed no increase in blast population. The recent blood test showed haemoglobin level of 10 g/dl. Now, I am taking - Lenmclid (5 mg), Ecospirin (75 mg), Aterva (20 mg), Teltex and Clopitab (75 mg). Why am I unable to walk properly? Is it a warning signal? What causes myelodysplastic syndrome? Is it incurable? How can it be managed?

A:Myelodysplastic syndrome (MDS) occurs due to some genetic mutation or toxic injury to the bone marrow, and is mainly a disease of the elderly. This is an incurable sort of disease, the only curative option being an allogenic stem cell transplant if an HLA matched donor is available. This procedure itself carries high mortality in advanced age. The decision to treat the disease is made following a detailed diagnosis i.e. subtype of MDS, cytogenetics, percentage of blasts in marrow and types of cytopenia. Yes, it’s a warning signal, some time it may convert to acute leukemia, which is a nasty from of blood cancer. No, you can take treatment under the care of a haematologist / haemato-oncologist in your city. There is no current recommendation to give lenalidomide (which works fairly in patient with MDS 5q - syndrome) with Decogen. Check with your doctor as you should get only one form of therapy. Decogen keeps patients away from blood transfusions in 30-40% cases, so you may have to continue it as a maintenance therapy if you respond to it.