MDS: Treatment Options and Blood Count Concerns

MDS Disease Issues 2

Thank you for the doctor's response.
I would like to ask another question: my blast count is over 5%, but I do not have anemia, my platelet count is normal, and my white blood cell count is between 13,000 and 16,000.
Does this mean that I cannot use this new medication and will have to wait until my condition worsens before the health insurance will cover it? Thank you!

chun, 30~39 year old female. Ask Date: 2015/04/18

Dr. Chen Yunfang reply Oncology

According to the National Health Insurance reimbursement regulations, there is no specific requirement for blood cell counts to be above or below a certain level in order to use Azacitidine; it is sufficient that you have MDS RAEB (regardless of whether it is RAEB-1 or RAEB-2).
Therefore, based on the information you have provided, you are eligible to apply for its use.
(Even if your blast count is slightly above 5 and your white blood cell count is somewhat elevated.) However, based on my clinical experience, I would likely not apply for this medication for you at this time, as your blood test results appear to be acceptable.
I would prefer to perform a bone marrow biopsy every 3-6 months, and if there is an increase in blast count or more significant abnormalities in your peripheral blood, then I would consider applying for this medication under the National Health Insurance.
Azacitidine is, after all, a chemotherapy drug with associated side effects (such as injections, nausea, and vomiting).
Weighing the pros and cons, I would prefer to closely monitor your condition.
I wonder if your hematologist has explained it in a similar manner? Wishing you peace and well-being.

Reply Date: 2015/04/18

More Info

Myelodysplastic Syndromes (MDS) are a group of disorders caused by poorly formed or dysfunctional blood cells. Patients with MDS often experience a range of symptoms due to ineffective hematopoiesis, which can lead to anemia, leukopenia, and thrombocytopenia. The treatment options for MDS can vary significantly based on the specific subtype, the severity of the disease, and the patient's overall health.

In your case, you mentioned having a blast percentage of around 5%, normal platelet counts, and white blood cell counts ranging from 13,000 to 16,000. This indicates that while you have some degree of disease activity, your blood counts are relatively stable at the moment. The concern you raised about needing to wait for your condition to worsen before being eligible for new treatments is a common one among patients with MDS.

According to the healthcare regulations in many regions, including Taiwan, the eligibility for certain treatments, such as Azacitidine, does not strictly depend on the absolute values of blood counts but rather on the classification of the MDS. For instance, if you are classified as having Refractory Anemia with Excess Blasts (RAEB), you may be eligible for treatment regardless of your current blood counts. The key factor is whether your condition meets the criteria for the specific treatment based on your diagnosis.

It is important to understand that while your current blood counts may appear stable, MDS is a progressive disease, and monitoring is crucial. Regular blood tests are essential to track any changes in your blood counts and the percentage of blasts. If your blast percentage increases or if you start experiencing symptoms related to low blood counts, it may prompt your healthcare provider to consider initiating treatment sooner rather than later.

The treatment landscape for MDS has evolved, and there are several options available. Azacitidine is one of the most commonly used drugs for patients with higher-risk MDS. It works by modifying the bone marrow environment and promoting the production of healthy blood cells. However, it is also important to consider the potential side effects of any treatment, including the risk of further suppressing bone marrow function.

In your situation, it might be beneficial to have an open discussion with your hematologist about your concerns regarding treatment timing and eligibility. They can provide insights into the rationale behind treatment decisions and help you understand the potential risks and benefits of starting treatment at different stages of your disease. Additionally, they can explain the criteria for using new medications and whether your current condition warrants immediate action or if close monitoring is the best approach.

In conclusion, while your current blood counts may not indicate an immediate need for treatment, it is essential to maintain regular follow-ups and stay informed about your condition. MDS is a complex disease, and treatment decisions should be tailored to each patient's unique circumstances. Engaging in a dialogue with your healthcare team will empower you to make informed decisions about your treatment plan and overall health management.

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