Myelodysplastic Syndromes (MDS)

Myelodysplastic Syndromes (MDS)
Updated: 05/31/2018
© Jun Wang, MD, PhD

General features
  • Clonal disorders of marrow stem cells
  • Ineffective or disorderly hematopoiesis
  • Usually older patients
  • Need to be ruled out in any adults with unexplained cytopenias or monocytosis
  • Diagnostic approaches include CBC, bone marrow biopsy/aspirate, cytogenetics analysis, molecular studies including FISH, single nucleotide polymorphism arrays, DNA sequencing
Clinical presentations
  • Associated with lineage affected
  • Anemia
  • Defected platelet aggregation
Key risk factors
  • Cytotoxic chemotherapy
  • Radiation
  • Viral infection
  • Genotoxic chemicals, such as benzene
Key Laboratory findings
  • Increased cellularity in marrow with decreased circulating blood cells
  • Dysplasia in one or more myeloid cell lines
  • < 20% blasts
Key morphological features
Genetic abnormalities
  • Balanced chromosomal abnormality with fusion of oncogenes
  • Complex karyotypes
  • Normal karyotype may present
Current classification
  • Refractory anemia (RA): <5% blasts, <15% ringed sideroblasts, unilineage dysplasia >10% in one myeloid lineage
  • RA with Ringed Sideroblasts (RARS): 15% or more sideroblasts, less than 5% blasts, erythroid dysplasia only
  • Refractory cytopenia with multilineage dysplasia (RCMD): cytopenia, <5% blasts, dysplasia in >10% of cells in two or more lineages, no Auer rods
  • RA with Excess Blasts (RAEB): Unilineage or multilineage dysplasia with 5-9% blasts, no Auer rods in Type 1; or 10-19% blasts, Auer rods may be present in Type 2
  • MDS with isolated 5q- syndrome: anemia, <5% blasts, no Auer rods, hypolobulated megakaryocytes
  • Unclassified: cytopenia(s), dysplasia in <10% of cells in one or more myeloid cell lines, accompanied by cytogenetics abnormalities with presumptive evidence of MDS, <5% blasts
  • Therapy related MDS


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