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==Overview==
==Overview==
Myelodysplastic syndrome may be classified into several subtypes based on the [[French-American-British classification|French-American-British (FAB) classification]] and [[World Health Organization]] the (WHO) classification methods.<ref name=radiopaedia>Classification of myelodysplastic syndrome. Radiopaedia (2015). http://radiopaedia.org/articles/myelodysplastic-syndrome. Accessed on December 7, 2015</ref><ref name=cancergov2>Pathologic systems of myelodysplastic syndrome. National Cancer Institute (2015). http://www.cancer.gov/types/myeloproliferative/hp/myelodysplastic-treatment-pdq/#link/_204_toc. Accessed on December 7, 2015</ref><ref name=wikipedia>French-American-British (FAB) classification of myelodysplastic syndrome. Wikipedia (2015). https://en.wikipedia.org/wiki/Myelodysplastic_syndrome. Accessed on December 7, 2015</ref><ref name=wikiWHO>World Health Organization classification of myelodysplastic syndrome. Wikipedia (2015). https://en.wikipedia.org/wiki/Myelodysplastic_syndrome. Accessed on December 8, 2015</ref>
The myelodysplastic syndrome may be classified into several subtypes based on the [[French-American-British classification|French-American-British (FAB) classification]] and the[[World Health Organization]] (WHO) classification methods.
 
==Classification==
==Classification==
===French-American-British (FAB) Classification===
===French-American-British (FAB) Classification===
*Myelodysplastic syndrome may be classified according to the [[French-American-British classification|French-American-British classification]] into five groups: Refractory anemia, refractory anemia with ring sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, and chronic myelomonocytic leukemia.<ref name=radiopaedia>Classification of myelodysplastic syndrome. Radiopaedia (2015). http://radiopaedia.org/articles/myelodysplastic-syndrome. Accessed on December 7, 2015</ref><ref name=cancergov2>Pathologic systems of myelodysplastic syndrome. National Cancer Institute (2015). http://www.cancer.gov/types/myeloproliferative/hp/myelodysplastic-treatment-pdq/#link/_204_toc. Accessed on December 7, 2015</ref><ref name=wikipedia>French-American-British (FAB) classification of myelodysplastic syndrome. Wikipedia (2015). https://en.wikipedia.org/wiki/Myelodysplastic_syndrome. Accessed on December 7, 2015</ref>
*Myelodysplastic syndrome may be classified according to the [[French-American-British classification|French-American-British classification]] into five groups: Refractory [[anemia]], refractory anemia with ring sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, and chronic myelomonocytic leukemia.
*The table below lists [[French-American-British classification|FAB]] classification for myelodysplastic syndrome:<ref name=radiopaedia>Classification of myelodysplastic syndrome. Radiopaedia (2015). http://radiopaedia.org/articles/myelodysplastic-syndrome. Accessed on December 7, 2015</ref><ref name=cancergov2>Pathologic systems of myelodysplastic syndrome. National Cancer Institute (2015). http://www.cancer.gov/types/myeloproliferative/hp/myelodysplastic-treatment-pdq/#link/_204_toc. Accessed on December 7, 2015</ref><ref name=wikipedia>French-American-British (FAB) classification of myelodysplastic syndrome. Wikipedia (2015). https://en.wikipedia.org/wiki/Myelodysplastic_syndrome. Accessed on December 7, 2015</ref>
*The table below lists [[French-American-British classification|FAB]] classification for myelodysplastic syndrome:<ref name="cancergov2">Pathologic systems of myelodysplastic syndrome. National Cancer Institute (2015). http://www.cancer.gov/types/myeloproliferative/hp/myelodysplastic-treatment-pdq/#link/_204_toc. Accessed on December 7, 2015</ref>


{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"
|valign=top|
| valign="top" |
|+
|+
! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Name'''
! style="background: #4479BA; width: 250px; color: #FFFFFF;" |'''Name'''


! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''
! style="background: #4479BA; width: 600px; color: #FFFFFF;" |'''Description'''


|-
|-


| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Refractory anemia'''|| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''Refractory anemia'''|| style="padding: 5px 5px; background: #F5F5F5;" |
:* Less than 5% primitive blood cells (myeloblasts) in the bone marrow and pathological abnormalities primarily seen in red blood cell precursors.
:* Less than 5% primitive blood cells (myeloblasts) in the bone marrow and pathological abnormalities primarily seen in red blood cell precursors.


|-
|-


| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Refractory anemia with ring sideroblasts (RARS)'''|| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''Refractory anemia with ring sideroblasts (RARS)'''|| style="padding: 5px 5px; background: #F5F5F5;" |
:* Less than 5% myeloblasts in the bone marrow, but distinguished by the presence of ringed sideroblasts which may compose greater than 15% of red blood cell precursor in the marrow.
:* Less than 5% myeloblasts in the bone marrow, but distinguished by the presence of ringed sideroblasts which may compose greater than 15% of red blood cell precursor in the marrow.


|-
|-


| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Refractory anemia with excess blasts (RAEB)'''|| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''Refractory anemia with excess blasts (RAEB)'''|| style="padding: 5px 5px; background: #F5F5F5;" |
:* 5-20% myeloblasts in the marrow
:* 5-20% myeloblasts in the marrow


|-
|-


| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Refractory anemia with excess blasts in transformation (RAEB-T)'''|| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''Refractory anemia with excess blasts in transformation (RAEB-T)'''|| style="padding: 5px 5px; background: #F5F5F5;" |
:*21-30% myeloblasts in the marrow (>30% blasts is defined as acute myeloid leukemia)
:*21-30% myeloblasts in the marrow (>30% blasts is defined as acute myeloid leukemia)


|-
|-


| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Chronic myelomonocytic leukemia (CMML)'''|| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''Chronic myelomonocytic leukemia (CMML)'''|| style="padding: 5px 5px; background: #F5F5F5;" |
:*Less than 20% myeloblasts in the bone marrow and greater than 1*109/L monocytes in peripheral blood
:*Less than 20% myeloblasts in the bone marrow and greater than 1*109/L monocytes in peripheral blood


|}
|}
===WHO Classification===
===WHO Classification===
*Myelodysplastic syndromes may be classified according to the WHO classification method into eight subtypes: Refractory anemia, refractory cytopenia with unilineage dysplasia, refractory anemia with ring sideroblasts, refractory cytopenia with multilineage dysplasia, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, and unclassifiable myelodysplastic syndrome.<ref name=cancergov2>Pathologic systems of myelodysplastic syndrome. National Cancer Institute (2015). http://www.cancer.gov/types/myeloproliferative/hp/myelodysplastic-treatment-pdq/#link/_204_toc. Accessed on December 7, 2015</ref><ref name=wikiWHO>World Health Organization classification of myelodysplastic syndrome. Wikipedia (2015). https://en.wikipedia.org/wiki/Myelodysplastic_syndrome. Accessed on December 8, 2015</ref>
*The table below lists World Health Organization classification for myelodysplastic syndrome:<ref name="cancergov2">Pathologic systems of myelodysplastic syndrome. National Cancer Institute (2015). http://www.cancer.gov/types/myeloproliferative/hp/myelodysplastic-treatment-pdq/#link/_204_toc. Accessed on December 7, 2015</ref><ref name="pmid29085786">{{cite journal |vauthors=Hong M, He G |title=The 2016 Revision to the World Health Organization Classification of Myelodysplastic Syndromes |journal=J Transl Int Med |volume=5 |issue=3 |pages=139–143 |date=September 2017 |pmid=29085786 |pmc=5655460 |doi=10.1515/jtim-2017-0002 |url=}}</ref><ref name="ArberOrazi2016">{{cite journal|last1=Arber|first1=D. A.|last2=Orazi|first2=A.|last3=Hasserjian|first3=R.|last4=Thiele|first4=J.|last5=Borowitz|first5=M. J.|last6=Le Beau|first6=M. M.|last7=Bloomfield|first7=C. D.|last8=Cazzola|first8=M.|last9=Vardiman|first9=J. W.|title=The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia|journal=Blood|volume=127|issue=20|year=2016|pages=2391–2405|issn=0006-4971|doi=10.1182/blood-2016-03-643544}}</ref>
*The table below lists World Health Organiztion classification for myelodysplastic syndrome:<ref name=cancergov2>Pathologic systems of myelodysplastic syndrome. National Cancer Institute (2015). http://www.cancer.gov/types/myeloproliferative/hp/myelodysplastic-treatment-pdq/#link/_204_toc. Accessed on December 7, 2015</ref><ref name=wikiWHO>World Health Organization classification of myelodysplastic syndrome. Wikipedia (2015). https://en.wikipedia.org/wiki/Myelodysplastic_syndrome. Accessed on December 8, 2015</ref>


{| style="border: 0px; font-size: 90%; margin: 3px; width: 800px"
{| style="border: 0px; font-size: 90%; margin: 3px; width: 800px"
|valign=top|
 
|+
|+
! style="background: #4479BA; width: 200px; color: #FFFFFF;"|'''Old system'''
! colspan="1" rowspan="1" style="background: #4479BA; width: 200px; color: #FFFFFF;" |2008


! style="background: #4479BA; width: 200px; color: #FFFFFF;"|'''New system'''
! colspan="1" rowspan="1" style="background: #4479BA; width: 200px; color: #FFFFFF;" |2016


|-
|-


| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''[[Refractory anemia]]'''
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #F5F5F5;" align="left" |Refractory cytopenia with unilineage dysplasia (RCUD)
| style="padding: 5px 5px; background: #F5F5F5;" align=center |
*    Refractory anemia (RA)
Refractory cytopenia with unilineage dysplasia
*    Refractory neutropenia (RN)
|-
*    Refractory thrombocytopenia (RT)
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''[[Refractory anemia with ringed sideroblasts]]'''
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #F5F5F5;" align="left" |MDS with single lineage dysplasia (MDS-SLD)
| style="padding: 5px 5px; background: #F5F5F5;" align=center |
Refractory anemia with ring sideroblasts
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #F5F5F5;" align="left" |Refractory anemia with ring sideroblasts (RARS)
|style="padding: 5px 5px; background: #F5F5F5;" align=center |
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #F5F5F5;" align="left" |MDS with ring sideroblasts (MDS-RS)
Refractory cytopenia with multilineage dysplasia
* MDS-RS-SLD
* MDS-RS-MLD
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''[[Refractory anemia with excess blasts]]'''
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #F5F5F5;" align="left" |Refractory cytopenias with multilineage dysplasia
| style="padding: 5px 5px; background: #F5F5F5;" align=center |
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #F5F5F5;" align="left" |MDS with multilineage dysplasia (MDS-MLD)
Refractory anemias with excess blasts I and II
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''[[Refractory anemia with excess blasts in transformation]] I–IV '''
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #F5F5F5;" align="left" |Refractory anemia with excess blasts (RAEB)
| style="padding: 5px 5px; background: #F5F5F5;" align=center |
*RAEB-1
5q - syndrome
*RAEB-2
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #F5F5F5;" align="left" |MDS with excess blasts (MDS-EB)
*MDS-EB-1
*MDS-EB-2
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''[[Chronic myelomonocytic leukemia]]'''
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #F5F5F5;" align="left" |MDS with isolated del(5q)
| style="padding: 5px 5px; background: #F5F5F5;" align=center |
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #F5F5F5;" align="left" |MDS with isolated del(5q)
Myelodysplastic-myeloproliferative overlap syndromes
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #F5F5F5;" align="left" |MDS, unclassifiable (MDS-U)
| style="padding: 5px 5px; background: #F5F5F5;" align=center |
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #F5F5F5;" align="left" |MDS, unclassifiable (MDS-U)
Refractory cytopenia of childhood
|-
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #F5F5F5;" align="left" |Refractory cytopenia of childhood (provisional)
| style="padding: 5px 5px; background: #F5F5F5;" align=center |
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #F5F5F5;" align="left" |Refractory cytopenia of childhood (provisional)
Unclassifiable myelodysplastic syndrome
|}
|}


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]

Overview

The myelodysplastic syndrome may be classified into several subtypes based on the French-American-British (FAB) classification and theWorld Health Organization (WHO) classification methods.

Classification

French-American-British (FAB) Classification

  • Myelodysplastic syndrome may be classified according to the French-American-British classification into five groups: Refractory anemia, refractory anemia with ring sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, and chronic myelomonocytic leukemia.
  • The table below lists FAB classification for myelodysplastic syndrome:[1]
Name Description
Refractory anemia
  • Less than 5% primitive blood cells (myeloblasts) in the bone marrow and pathological abnormalities primarily seen in red blood cell precursors.
Refractory anemia with ring sideroblasts (RARS)
  • Less than 5% myeloblasts in the bone marrow, but distinguished by the presence of ringed sideroblasts which may compose greater than 15% of red blood cell precursor in the marrow.
Refractory anemia with excess blasts (RAEB)
  • 5-20% myeloblasts in the marrow
Refractory anemia with excess blasts in transformation (RAEB-T)
  • 21-30% myeloblasts in the marrow (>30% blasts is defined as acute myeloid leukemia)
Chronic myelomonocytic leukemia (CMML)
  • Less than 20% myeloblasts in the bone marrow and greater than 1*109/L monocytes in peripheral blood

WHO Classification

  • The table below lists World Health Organization classification for myelodysplastic syndrome:[1][2][3]
2008 2016
Refractory cytopenia with unilineage dysplasia (RCUD)
  •    Refractory anemia (RA)
  •    Refractory neutropenia (RN)
  •    Refractory thrombocytopenia (RT)
 MDS with single lineage dysplasia (MDS-SLD)
Refractory anemia with ring sideroblasts (RARS) MDS with ring sideroblasts (MDS-RS)
  • MDS-RS-SLD
  • MDS-RS-MLD
Refractory cytopenias with multilineage dysplasia MDS with multilineage dysplasia (MDS-MLD)
Refractory anemia with excess blasts (RAEB)
  • RAEB-1
  • RAEB-2
 MDS with excess blasts (MDS-EB)
  • MDS-EB-1
  • MDS-EB-2
MDS with isolated del(5q) MDS with isolated del(5q)
MDS, unclassifiable (MDS-U) MDS, unclassifiable (MDS-U)
Refractory cytopenia of childhood (provisional) Refractory cytopenia of childhood (provisional)

References

  1. ↑ 1.0 1.1 Pathologic systems of myelodysplastic syndrome. National Cancer Institute (2015). http://www.cancer.gov/types/myeloproliferative/hp/myelodysplastic-treatment-pdq/#link/_204_toc. Accessed on December 7, 2015
  2. ↑ Hong M, He G (September 2017). "The 2016 Revision to the World Health Organization Classification of Myelodysplastic Syndromes". J Transl Int Med. 5 (3): 139–143. doi:10.1515/jtim-2017-0002. PMC 5655460. PMID 29085786.
  3. ↑ Arber, D. A.; Orazi, A.; Hasserjian, R.; Thiele, J.; Borowitz, M. J.; Le Beau, M. M.; Bloomfield, C. D.; Cazzola, M.; Vardiman, J. W. (2016). "The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia". Blood. 127 (20): 2391–2405. doi:10.1182/blood-2016-03-643544. ISSN 0006-4971.


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