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Chronic Myeloid Neoplasms

Myelodysplastic syndromes

Refractory Cytopenia with Multilineage Dysplasia (RCMD)


Reviewer: Nikhil Sangle, M.D. (see Reviewers page)
Revised: 5 February 2012, last major update August 2011
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Clinical features
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● Cytopenia of 2-3 lineages and dysplastic changes in ≥10% of cells of 2-3 lineages, <5% myeloblasts in bone marrow and peripheral blood
● More aggressive than refractory anemia, 10% progress to acute leukemia at two years; median survival 30 months
● Some consider it an intermediate disorder between refractory anemia and refractory anemia with excess blasts
● Poor prognosis if even 1% blasts in peripheral blood (Leuk Res 2008;32:33)
● Proposed modified criteria are refractory anemia, >10% pseudo-Pelger-Huet anomalies, dysmegakaryopoiesis in ≥40% or micromegakaryocytes in ≥10%, and no 5q- syndrome (Leukemia 2007;21:678)
● Termed RCMD with ringed sideroblasts if ≥15% ringed sideroblasts (RCMD can have a variable number of ring sideroblasts)

Case reports
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● Associated with chloramphenicol and responsive to cyclosporine (Eur J Haematol 2006;76:255)

Treatment
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● Possibly splenectomy (Rom J Intern Med 2007;45:89)

Micro description
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Peripheral blood: cytopenia of 2-3 lineages, no/rare blasts, no Auer rods, < 1 billion/L monocytes
Bone marrow: dysplastic changes in 10% of cells of 2-3 lineages, <5% myeloblasts in bone marrow, no Auer rods

Micro images
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Various images

Differential diagnosis
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Refractory anemia: no dysplastic changes in granulocytes, platelets or megakaryocytes
Refractory anemia with excess blasts: myeloblasts >5%

End of Chronic Myeloid Neoplasms > Myelodysplastic syndromes > Refractory Cytopenia with Multilineage Dysplasia (RCMD)


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