Delayed Side Effects

As I have talked about (a LOT) during my treatment for FBC (f-bomb breast cancer), cancer therapy (especially chemo) can have side effects and that surface long after treatment for the original disease is gone. Some such side effects include liver damage, heart disease and even cancer itself. Yes, chemo can in fact cause other types of cancer.

And, yes, cancer brings out the f-bombs in me. Ahhhh, FBC.

On Good Morning America this morning, Robin Roberts told viewers (quite bravely, I might add) that her treatment for breast cancer triggered another serious disease called Myelodysplastic Syndrome, a/k/a MDS.

WTF is it, you ask? Myelodysplastic syndrome (formerly known as prelukemia) is a rare, malignant (i.e., cancerous) blood and bone marrow disorder.

WTF is bone marrow, you ask? Well, as you may recall from my FBC days, I like to explain things. So, to better understand what happens to your blood when a person has myelodysplastic syndrome, it helps to know the fundamentals about normal blood cells and where they come from.

So, let’s start from the beginning: there are three major types of blood cells:

1. Red blood cells (RBCs) are the major part of your blood. They carry oxygen and carbon dioxide throughout your body.
2. White blood cells (WBCs) include several different types. Each has its own role in protecting the body from germs. WBCs play a major role in fighting infection. Infections are more likely to occur when there are too few normal WBCs in the body. The three major types of WBCs are neutrophils, monocytes and lymphocytes.
1. Neutrophils destroy most bacteria.
2. Monocytes destroy germs such as tuberculosis.
3. Lymphocytes are responsible for destroying viruses and for overall management of the immune system. When lymphocytes see foreign material, they increase the body’s resistance to infection.
3. Platelets are the cells that help control bleeding by helping blood to clot normally. When you cut yourself, the platelets collect at the site of the injury and form a plug to stop the bleeding.

Bone Marrow is the soft, spongy material within the bones where blood cells are made. All blood cells begin in the bone marrow as stem cells. Stem cells are very immature cells. When there is a need, the stem cells are signaled to develop into mature RBCs, WBCs or platelets. Make sense?

Ok, so MDS is when things go haywire with the bone marrow, i.e., when the blood-forming cells in the bone marrow are damaged. This damage leads to low numbers of one or more type of blood cells. And because we need our RBCs, WBCs and Platelets to fundamentally fuel and protect us, this is not good.

Many people have no symptoms of MDS. However, when symptoms do present they tend to be

• Anemia (low RBCs)
• Fatigue (from the anemia)
• Easy bruising or bleeding (due to low platelets), and/or
• Frequent fevers or infections as a result of low numbers of infection-fighting cells.

The primary approach to treating MDS is a bone marrow transplant.

The goal is to take bone marrow from a healthy donor who has similar immune markers on their blood cells (in Roberts’ case, the donor will be her sister who is considered a perfect match – Silver Lining) and use it to replace and repair the abnormal bone marrow in the MDS patient. Before the transplant, Oncologists use chemotherapy to eliminate all of the cells in the patient’s bone marrow and then infuse the new bone marrow. Basically, the chemo wipes out the nonfunctioning bone marrow to make room for the new, donated bone marrow.

Who is at risk for MDS? Prior treatment with chemotherapy is the most important risk factor for MDS. Patients who have been treated with certain chemotherapy drugs for cancer are more likely to develop MDS. Other risk factors include: familial MDS, smoking (who on earth smokes anymore? I mean, really.), age, genetic syndromes, and being a man.

Robin Roberts is so cool.  She is turning her own scare with a rare bone marrow disorder into a call for organ donation (Silver Lining).

Her coolness is further highlighted in her blog post today when she referenced the highs and lows that happened simultaneously in her life:

I received my MDS diagnosis on the very day that Good Morning America finally beat the Today Show for the first time in 16 years. Talk about your highs and lows! Then a few weeks ago, during a rather unpleasant procedure to extract bone marrow for testing, I received word that I would interview President Obama the next day. The combination of landing the biggest interview of my career and having a drill in my back reminds me that God only gives us what we can handle and that it helps to have a good sense of humor when we run smack into the absurdity of life.

See what I mean about cool?  Sounds to me like she has found a whole lot of Silver Linings amidst her very trying circumstances.

I know that I’m not alone when I wish her all the very best (Silver Lining).