Other Blood Diseases
Patients with early myelofibrosis are treated symptomatically to keep the patient comfortable and minimize side-effects of more aggressive treatment. Patients with severe anemia require blood transfusions every one to three months. Hydroxyurea may be give to reduce painful splenomegaly, or the spleen may be surgically removed. Erythropoietin or androgens may stimulate red blood cell production. Sometimes chemotherapy and radiation therapy are used. A small proportion of myelofibrosis patients may develop acute myelogenous leukemia, which is treated with chemotherapy.
The primary treatment of the myelodysplastic syndromes is supportive therapy with blood transfusions of specific types of cells (rather than whole blood) and antibiotic treatment of any infections that may develop. Patients with fewer than 5% blasts have a long chronic phase during which they receive many red blood cell transfusions. Patients with more aggressive disease will progress more quickly to acute leukemia, which is treated with chemotherapy. Bone marrow transplantation is a treatment option for younger patients (less than age 55). Certain categories of cases are treatable with either low-dose or intensive (high dose) chemotherapy. Hematopoietic growth factors are an immunotherapy under clinical investigation. Other types of supportive care include vitamin therapy, steroids, and immunosuppressive agents.
Because this is a disease of over-production of red cells, it is treated by blood removal (phlebotomy or venisection). If cells other than red cells are also increased, radioactive phosphorus or chemotherapy may be used to suppress the abnormal and excessive cell production.
Supportive care is the standard treatment. Stable disease may need no treatment. Plasmapheresis (removal of the IgM antibody from the blood) may be effective for some patients. Other patients may respond to chemotherapy with chlorambucil.