Why does MDS cause fevers?

[Hopeful]

Does anyone know why it is said that fevers can be associated with MDS?

I have had a low grade fever (99-100.1) every afternoon and evening for months now. I've been blood cultured, x-rayed, and CT scanned and have no sign of an infection. I am not neutropenic. So, what is the theory behind fevers and MDS? Is this typical?

Thanks for any advice!

[Birgitta-A]

Hi Hopeful,
It is quite complicated to explain fever - low grade fever is common in many malignant diseases like MDS.

Internal pyrogens are substances that induce fever to the body. Many cytokines - signaling molecules that, like hormones and neurotransmitters, are used in cellular communication - are a part of the immune system and are pyrogens.

Examples of internal pyrogens are the cytokines tumor necrosis factor-alpha. interleukin-1 and interleukin-6.

These cytokines are released into general circulation from different kinds of white blood cells and migrate to the brain. The cytokines then bind with receptors on vessel walls, or interact with local cells. When these cytokines bind we get the febrile response from the brain.

Tumour necrosis factor-alpha is believed to play a major role in death of bone marrow cells in MDS.

Several cytokines – for example Neupogen – are used to treat MDS patients. Neupogen pushes the bone marrow so that the white blood cells increase .

When you have a disease like MDS you should not try to decrease fever with drugs because then you get a "false" low temperature. If the fever is due to an infection the false low temperature will prevent you from seeking help early while the infection is more easy to treat.

If this explanation is impossible to understand please post an answer and I will try to explain the difficult parts with other words.

Kind regards
Birgitta-A
70 yo, dx MDS Inter-1 May 2006, transfusion dependent, Desferal for iron overload, Neupogen 2 injections/week for low white blood cells

[helen c.]

my husband only gets neupogen after a week of vidaza and then 1 shot of procrit and 5 days of neupogen

[Hopeful]

Hi Birgitta,

I need help with your explanation! I tried attacking it with Wikipedia but still got lost pretty quickly Are IL-1 and IL-6 attacking the inflammation or causing it? Are they found in healthy white blood cells in the absence of disease? Is Neupogen necessary to increase white blood cells and reduce inflammation or is this only used when white blood cells are critically low? My white blood cells are around 2.8, so I haven't been on any growth factors so far. Are my fevers a sign that things are really amiss or just that my body is fighting a battle.

Thanks for your patience in explaining this to me!

[Mike Conlon]

Originally Posted by Hopeful

Does anyone know why it is said that fevers can be associated with MDS?

I have had a low grade fever (99-100.1) every afternoon and evening for months now. I've been blood cultured, x-rayed, and CT scanned and have no sign of an infection. I am not neutropenic. So, what is the theory behind fevers and MDS? Is this typical?

Thanks for any advice!

Sorry, no advice, can only quote my own experience. Since dx in May,07 I have not had a fever for a single day.

[launch]

My husband was just recently diagnosed with MDS, and we have not received the IPPS results yet. It's been a roller coaster ride, as I'm sure it has been for many people like us. We're slowly learning about this disorder, and of course, remain anxious quite a bit... we do continue to pray...

But, I'm replying mainly today because I see you are asking about a low grade fever... my husband has had one for weeks now... strange.

[Birgitta-A]

Hi Helen,
Sorry I didn’t see your questions though I read Marrowforums every day – they disappeared behind some other post .

Interleukin-1 (Il-1) fights infection by (1) making it more easy for white blood cells reach infections and (2) having an impact on a part of the brain called hypothalamus thermoregulatory center, leading to an increased body temperature which expresses itself as fever. The increased body temperature helps the body's immune system to fight infection.

Interleukin-6 (Il-6) IL-6 mediates fever. In the muscle and fatty tissue IL-6 stimulates energy mobilization which leads to increased body temperature.

Both are attacking inflammation – fever is one of our weapons when we fight infections.

Both are made by white blood cells and always found in the blood.

Neupogen is a growth factor for white blood cells. It stimulates the type of white blood cells called granulocytes (among them neutrophils) and is produced by bacteria into which has been inserted the human granulocyte colony-stimulating factor gene.

Neupogen is only used when the white blood cells are critically low. The important white blood cells called neutrophils are about 50 % of the white blood cells so when your white blood cells are 2.8 your neutrophils are about 1.4. Less than 1.5 neutrophils is called mild neutopenia – you should be very careful and try to avoid all kinds of infections because your bone marrow has problems to make neutrophils that can fight infections. http://www.neutropenia.ca/about/index.html

It is very difficult to know why you have fever . In any case you should control it - as you probably already do - morning and evening and seek help if it is going up.
Kind regards
Birgitta-A