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Managing the Side Effects of Myelodysplastic Syndrome (MDS) and MDS Treatment

The information provided here is meant to give you a general idea about each of the supportive care options, including medications, listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these as advised by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Supportive care measures may help to either prevent or reduce side effects of treatment, or to manage certain side effects once they occur. Since you can develop these symptoms from the treatment and/or from the disease itself, it is essential that you discuss them with your doctor when you notice and ask if any of these treatments are appropriate for you.


Common names include:

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

MDS that reduces white blood cell counts cause impairment of the immune system. The impairment increases the risk of infections. Most infections affect the respiratory system or skin. Though your doctor may prescribe an antibiotic for certain infections, prophylactic use of these medications is not generally done. Antibiotics can be taken by mouth or applied to the skin. In severe cases, an antibiotic can be given by IV.

Possible side effects include:

Blood Stem Cell Support Drugs

Common names include:

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

During cancer treatment, blood cells can be destroyed along with cancer cells. Filgrastim and sargramostim help your bone marrow make new white blood cells. White blood cells help your body fight infection. Therefore, filgrastim and sargramostim help to reduce your risk of infection. Both are taken as an injection under the skin.

Epoetin helps your bone marrow to make new red blood cells. Low red blood cell levels can lead to anemia. Therefore, epoetin helps reduce your risk of anemia. Epoetin is effective, but it has a 2 week delay between the injection and when your red blood cell count starts to come back. Epoetin is given through an IV or as an injection. Darbepoetin alfa may be given every 2-4 weeks as an injection. It is not used as a quick fix for a low red blood cell count. A blood transfusion is usually performed if you need to recover your red blood cell count more quickly.

Oprelvekin helps the bone marrow make platelets. Low platelet levels make it hard for the blood to clot. Bleeding can occur with a small cut or internally. Using oprelvekin can help reduce blood clotting time. It is given as an injection.

These medications are often combined with chemotherapy.

Possible side effects of epoetin include:

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

Possible side effects of filgrastim include:

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

Possible side effects of oprelvekin include:

  • Rash
  • Nausea
  • Thrush
  • Shortness of breath
  • Lightheadedness
  • Fatigue
  • 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. This helps with treating anemia symptoms, and improving infection control and blood clotting. Blood is given through an IV. The blood comes from a donor. Donated blood must match your blood type. Though donor and recipient blood is tested for type, you will be monitored for any signs of an adverse reaction during the transfusion.

Blood transfusions do not offer a cure, but they do improve symptoms by raising blood cell counts. Since each blood components have limited lifespans, transfusions will need to be repeated. Generally, frequent transfusions increase the likelihood of becoming resistant to future transfusions.

Possible side effects include:

  • Transfusion reaction—The immune system may recognize the new cells as foreign and attack them. The risk of a reaction increases with each transfusion. Symptoms may include fever, chills, a rash back pain, blood in the urine, lightheadedness, or fainting.
  • Hemochromatosis—Excess iron in the blood may cause it to be deposited in the skin and organs like the liver, heart, or pancreas. This can lead to organ damage, which may lead to heart failure or diabetes. Excess iron can be removed from the body with the deferoxamine, a chelating agent, which is given by IV.
  • Infection—A single unit of blood may include transmission of hepatitis B and C, HIV, and—rarely—other blood-born infections, such as malaria. In general, the risk of transfusion-related infection is far outweighed by the benefits.

Hypomethylating Agents

The primary defect in MDS is the failure of the blood stem cell to mature and become a specific type of blood cell in a process called differentiation. Recently, it has been discovered that certain chemicals, among them anti-cancer drugs, have the ability to promote cell differentiation. Two hypomethylating agents are used in the treatment of MDS. They work on genes to slow cell growth and kill cancer cells. The drugs used are decitabine and azacytidine.

They are used to treat certain types of MDS, as well as acute myeloid leukemia. The medications are given by IV in treatment cycles to help improve bone marrow functioning and normalize blood cell counts.

Possible side effects include:

  • Harm to an unborn baby—Women should not become pregnant while being treated with decitabine, and men should not father a child while receiving decitabine and for 2 months after treatment ends.
  • Low red blood cell count—anemia
  • Low white blood cell count—neutropenia
  • Low platelet count—thrombocytopenia
  • Nausea or vomiting
  • Lightheadedness
  • Constipation
  • Fatigue
  • Fever
  • Itching and/or rash

Other substances that are being studied for use as differentiation agents include vitamin A derivatives, vitamin D3, arsenicals, and interferon type 1.


Immunotherapy is used to modify, enhance, or suppress the immune system. Thalidomide and lenalidomide are used to treat people wo have the isolated del (5q) abnormality type of MDS. Thalidomide has been used longer, but lenalidomide has better success with fewer side effects. These drugs increase red blood cell counts and help with bone marrow function. Thalidomide and lenalidomide are taken by mouth.

Possible side effects include:

  • Severe, life-threatening birth defects or death of an unborn baby—Because lenalidomide is chemically similar to thalidomide, female patients must not get pregnant 4 weeks before treatment, must not take lenalidomide during pregnancy, and must not take the medication 4 weeks after pregnancy.
  • Low white blood cell count
  • Low platelet count
  • Blood clots in the veins and lungs
  • Diarrhea
  • Itching
  • Rash
  • Fatigue

Anti-thymocite globulin (ATG) and cyclosporine have been useful in treating some people with MDS, especially ones who are younger. These drugs suppress the body's immune response to specific types of white blood cells. Both drugs can be taken by mouth, but cyclosporine can also be given through an IV.

Possible side effects of ATG include:

  • Serious allergic reaction
  • Low blood pressure
  • Difficulty breathing
  • Fever
  • Headache
  • Abdominal pain
  • Muscle aches
  • Nausea
  • Diarrhea

Possible side effects of cyclosporine include:

  • Headache
  • Fever
  • Nausea or vomiting
  • Increase in blood pressure
  • Hair growth
  • Gum enlargement
  • Numbness or tingling

General Information about Medications

If you are taking medications, follow these general guidelines:

  • Take the medication as directed. Do not change the amount or the schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medication.
  • Do not share your prescription medication.
  • Medications can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one medication, including over-the-counter products and supplements.
  • Plan ahead for refills as needed.

Azacitidine. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T232950/Azacitidine. Updated June 16, 2017. Accessed June 30, 2017.

Decitabine. EBSCO DynaMed website. Available at:http://www.dynamed.com/topics/dmp~AN~T233014/Decitabine. Updated June 16, 2017. Accessed June 30, 2017.

Myelodysplastic syndrome. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114054/Myelodysplastic-syndrome-MDS. Updated January 13, 2017. Accessed June 30, 2017.

Myelodysplastic syndrome. Merck Manual Professional Version website Available at: http://www.merckmanuals.com/professional/hematology-and-oncology/leukemias/myelodysplastic-syndrome. Updated January 2017. Accessed June 30, 2017.

Treating myelodysplastic syndromes. American Cancer Society website. Available at: https://www.cancer.org/cancer/myelodysplastic-syndrome/treating.html. Accessed June 30, 2016.

Treatment option overview. National Cancer Institute website. Available at: https://www.cancer.gov/types/myeloproliferative/patient/myelodysplastic-treatment-pdq#section/_49. Updated August 12, 2015. Accessed June 30, 2017.

Last reviewed June 2017 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP  Last Updated: 6/30/2016