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Chronic Myeloid Neoplasms

Myelodysplastic syndromes

MDS - WHO classification


Reviewer: Nikhil Sangle, M.D. (see Reviewers page)
Revised: 12 August 2011, last major update August 2011
Copyright: (c) 2001-2011, PathologyOutlines.com, Inc.

WHO 2008 Classification
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Refractory anemia (RA): <5% blasts, <15% ringed sideroblasts; variable marrow cellularity, unicytopenia or bicytopenia, 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): type 1 has 5-9% blasts in blood/marrow, peripheral cytopenia, unilineage or multilineage dysplasia, no Auer rods; type 2 has 10-19% blasts in blood/marrow, unilineage or multilineage dysplasia, Auer rods may be present, peripheral cytopenia
MDS with isolated 5q- syndrome: anemia, <5% blasts, del(5q), no Auer rods, normal/increased hypolobated megakarycoytes
MDS, unclassified: cytopenia(s), dysplasia in <10% of cells in one or more myeloid cell lines, accompanied by cytogenetic abnormalities with presumptive evidence of MDS, <5% blasts
Therapy related MDS

Changes of WHO 2001 from FAB =========================================================================

● Reduced blast requirement for AML from 30% to 20%, eliminated RAEB-T category (but see Acta Haematol 2007;117:221), added multilineage dysplasia and 5q- syndrome, shifted CMML to new group of MDS/MPN (Blood 2002;100:2292)
● Better than FAB in predicting outcome (Br J Haematol 2007;137:193, Blood 2004;103:3265)

French American British (FAB) classification system for myelodysplasia (used prior to WHO)
=========================================================================

● Refractory anemia (RA): <5% blasts, <15% ringed sideroblasts; variable marrow cellularity
● RA with Ringed Sideroblasts (RARS): 15% or more sideroblasts, less than 30% erythroblasts
● RA with Excess Blasts (RAEB): 5-30% blasts in marrow, < 5% in peripheral blood
● RA with Excess Blasts in Transformation (RAEB-T): 20-30% blasts in marrow, >5% in peripheral blood (now AML in WHO classification)
● Chronic myelomonocytic leukemia (CMML): elevated WBC, monocytosis > 1 billion/liter; trilinear dysplasia; 5-20% blasts in marrow, <5% in peripheral blood
● MDS, unclassified

End of Chronic Myeloid Neoplasms > Myelodysplastic syndromes > MDS - WHO classification


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