Myelodysplastic syndromes. | Aplastic Anemia and MDS International Foundation

Myelodysplastic syndromes.

Journal Title: 
J Natl Compr Canc Netw
Author(s): 
Greenberg PL, Attar E, Bennett JM, Bloomfield CD, De Castro CM, Deeg HJ, Foran JM, Gaensler K, Garcia-Manero G, Gore SD, Head D, Komrokji R, Maness LJ, Millenson M, Nimer SD, O'Donnell MR, Schroeder MA, Shami PJ, Stone RM, Thompson JE, Westervelt P
Primary Author: 
Greenberg PL
Original Publication Date: 
Saturday, January 1, 2011

Overview The myelodysplastic syndromes (MDS) represent myeloid clonal hemopathies with relatively heterogeneous spectrums of presentation. The major clinical problems in these disorders are morbidities caused by cytopenias and the potential for MDS to evolve into acute myeloid leukemia (AML). In the general population, MDS occur in 5 per 100,000 people. However, among individuals older than 70 years, the incidence increases to between 22 and 45 per 100,000 and increases further with age. Managing MDS is complicated by the generally advanced age of the patients (median ages, 65-70 years), attendant nonhematologic comorbidities, and relative inability to tolerate certain intensive forms of therapy among older patients. In addition, when the illness progresses to AML, these patients experience lower response rates to standard therapy than those with de novo AML.(1) Diagnostic Classification Initial evaluation of patients with suspected MDS requires careful assessment of their peripheral blood smear and blood counts, marrow morphology, duration of their abnormal blood counts, other potential causes for their cytopenias, and concomitant illnesses. The French-American-British (FAB) classification initially categorized patients for the diagnostic evaluation of MDS.(2) Dysplastic changes in at least 2 of the 3 hematopoietic cell lines have been used by most histopathologists to diagnose MDS. These changes include megaloblastoid erythropoiesis, nucleocytoplasmic asynchrony in the early myeloid and erythroid precursors, and dysmorphic megakaryocytes.(3) Patients with MDS are classified as having 1 of 5 subtypes of disease: refractory anemia (RA); RA with ringed sideroblasts (RARS); RA with excess of blasts (RAEB); RAEB in transformation (RAEB-T); or chronic myelomonocytic leukemia...

Bone Marrow Diseases: