Dr. Sunil Gandhi, Cancer & Blood Disease, 10/16/12

I’ve known Mrs. Smith for a long time. She has been my patient for 10 years. She came to see me initially in 2002 and had anemia. She had a bone marrow biopsy, which showed Myelodysplastic syndrome (MDS). She was 84 years old at that time.

This usually affects senior citizens. Normally, the bone marrow makes blood stem cells (immature cells) that become mature blood cells over time. In Myelodysplastic syndromes, the blood stem cells do not mature into healthy red blood cells, white blood cells, or platelets. The immature blood cells, called blasts, do not function normally and either die in the bone marrow or soon after they enter the blood. This leaves less room for healthy white blood cells, red blood cells and platelets to form in the bone marrow. When there are fewer blood cells, infection, anemia, or easy bleeding may occur.

After few years, her anemia worsened significantly and she needed to be started on erythropoietin or Procrit injections. It is a natural substance secreted by the kidneys. It stimulates bone marrow to make more RBCs (red blood cells). In my patient with MDS, bone marrow does not produce RBCs well and so Procrit helps. It cannot be given orally but it needs to be given as injection.

Initially, she responded well to Procrit and that lasted for many years. Later on, both my patient and I realized that she needs more and more Procrit and she still started needing blood transfusions.

Now, she is 94 and has transfusion-dependent anemia. She was also feeling increasingly tired. She still is active and able to take care of herself but is fatigued. Her quality of life deteriorated due to worsening anemia.

I had a long discussion with the patient and her family. The options were status quo vs. trying a mild chemotherapy drug. She is now 94 and so obviously, there is hesitation for chemotherapy at her age. This is mild treatment, which is well tolerated and usually does not cause any nausea, vomiting or hair loss.

The patient was very determined and not ready for status quo and so I started her on mild chemotherapy with Vidaza. She is tolerating it very well. This is given seven consecutive days in the vein and it is repeated every four weeks.Her anemia markedly improved. She has not received any more blood transfusions and her quality of life has improved significantly. 

This case clearly shows that age is not a bar to chemotherapy. We should focus on the overall condition of the patient and disease process. Also remember, there are different kinds of chemotherapy and so do not treat all chemotherapy drugs as toxic and refuse. Rather than getting scared of the treatment, she decided to embrace chemotherapy and is doing much better.