[DanL]

Bone marrow fibrosis is not a rare finding in MDS patients and reflects marrow stress. Fibrosis simply means scarring of the bone marrow. What happens is that the reticulin fibers become more dense and less capable of producing good blood cells. Severe fibrosis indicates the presence of collagen fibers (like your nails or hair). Most MDS cases with fibrosis are grades 1-2, although it can be grade 3. The prognosis of the presence of fibrosis in MDS patients is not well defined, but generally if there is a lot of grade 3 fibrosis, it would mean that a substantially smaller portion of the marrow is capable of producing healthy blood cells. The fibrosis, in effect, crowds the marrow, which is supposed to be spongy and soft.

I was level 2 - 3 when I was transplanted in 2014, but am currently free of any notable fibrosis. From what I have read, it appears that it can be a complicating factor that may increase risk during transplant, which may include higher relapse rates - which I did experience.

Overall, I think that it is a relevant factor, but it is not the predominant concern when treating MDS, as most cases don't have the JAK-2 mutation that is present in myelofibrosis. I have seen cases where the JAK-2 mutation is present and where people are treated with anti-myelofibrosis drugs with some success. For the most part, the science indicates that in the absence of the above mutation, treatment for MDS is the proper path.

I hope that this information is helpful.