Background of Myelodysplastic Syndromes or MDS

Myelodysplastic syndromes or MDS is not a single disease but a group of disorders affecting the bone marrow, with the abnormality being most prominently reflected as a lowering of blood counts. In fact, one way to think of the complexity of MDS is to think of it as being to the bone marrow what pneumonia is to the lungs; the response of an organ to a variety of causes like aging, toxic exposure, infections, and auto-immunity.   Amongst infections of the lungs alone, pneumonia could be the result of a variety of possible pathogens including bacterial, viral, tuberculous, or fungal agents.  Similarly, MDS is the response of the bone marrow to a variety of unknown insults and cannot be treated as a single disease. There are two things that all patients with MDS share; first there is a lowering of one or more blood counts and second, the bone marrow cells look abnormal or “dysplastic”.

Cells that are circulating in our blood are born in the bone marrow from a small number of primitive “stem cells”. MDS is a disease of A SINGLE  bone marrow stem cell which then starts producing ineffective and abnormal blood cells. There are two main forms of blood cells; Lymphoid and Myeloid. As the name implies, MDS is a disease of the myeloid cells; dysplasia means that the cells look abnormal. Our blood contains three types of myeloid cells; red blood cells or RBCs which carry oxygen in the form of hemoglobin to all parts of the body, white blood cells or WBCs which are mainly responsible for fighting infections, and platelets which stop bleeding. Lowering of RBCs leads to a decrease in hemoglobin or anemia. Decrease in WBCs, especially the neutrophils (referred to as an absolute neutrophil count or ANC) increase the risk of infections. A decline in platelets, especially a count under 30,000/ul, leads to a susceptibility towards bleeding. MDS patients present with a lowering of one or more types of these blood cells, the most common cell type affected being red cells. This makes anemia a universal hallmark of the disease. It is called Refractory Anemia  because the anemia of MDS patients does not respond to commonly employed therapies for anemia such as iron and vitamins.

The disease usually strikes older individuals, half the patients being older than 70 years of age. There are two types of MDS, one for which no cause is known called primary or de novo MDS, and the other which follows known and documented exposure to toxins/chemical agents such as benzene, chemotherapy, radiation therapy etc called secondary MDS. The vast majority of patients constituting ~90% of the MDS cases belong to the Primary MDS category while in <10% cases, the disease is a result of damage to the bone marrow produced by chemicals such as treatment for a prior malignancy.

Use of Natural, Non-Toxic Compounds to Treat MDS at UMass

The incidence of most cancers in Asian countries is dramatically lower than that in the USA. One of the critical reasons relates to diet. In India, spices containing onion, garlic, ginger, turmeric, red chilly, tomatoes, and black pepper are extensively used in daily foods, and many of these have now been scientifically proven to have anti-cancer effects. There are over 1000 papers published in highly respected medical journals on the biologic activity of curcumin (active ingredient of turmeric) and ginger in the last few years alone. At U Mass MDS Center, we have treatment protocols exploiting the chemo-preventive and anti-cancer properties of a variety of these natural and completely non-toxic substances with exciting results and unexpected successes. A protocol using the enzyme coQ10 in MDS patients has not only produced complete hematologic remissions in a subset of patients, but also, unexpectedly, cytogenetic remissions. Several protocols are available at U Mass where patients who are not only given these natural compounds but enormous resources are being invested in understanding the mechanism of action of these agents at the molecular, biochemical and genetic level through the latest technologies using micrarrays, gene-chips and proteomics. These studies will be helpful in guiding us towards a better understanding of how and when to use these natural compounds and also what combinations would be most effective. In future, we plan to combine low doses of other active drugs such as Thalidomide, Vidaza, Revlimid, arsenic with some of the naturally occurring compounds with higher efficacy and decreased toxicity.