Managing myelodysplastic symptoms in elderly patients

Figures & data

Table 1 WHO classification and criteria for the myelodysplastic syndromes³

Disorder	Peripheral blood	Bone marrow
Refractory anemia (RA)	Anemia	Erythroid dysplasia only
	No or rare blasts	<5% blasts
		<15% ringed sideroblasts
Refractory anemia with ringed sideroblasts (RARS)	Anemia	Erythroid dysplasia only
	No blasts	<5% blasts
		≥15% ringed sideroblasts
Refractory cytopenia with multilineage dysplasia (RCMD)	Bi- or pan-cytopenia	Dysplasia in ≥10% of cells in 2 or more myeloid cell lines
	No or rare blasts	No Auer rods
	No Auer rods	<5% blasts
	Monocytes <1,000/μL	<15% ringed sideroblasts
Refractory cytopenia with multilineage dysplasia and ringed sideroblasts (RCMD-RS)	Bi- or pan-cytopenia	Dysplasia in ≥10% of cells in 2 or more myeloid cell lines
	No or rare blasts	No Auer rods
	No Auer rods	<5% blasts
	Monocytes <1,000/μL	≥15% ringed sideroblasts
Refractory anemia with excess blasts-1 (RAEB-1)	Cytopenias	Unilineage or multilineage dysplasia
	<5% blasts	5% to 9% blasts
	No Auer rods	No Auer rods
	Monocytes <1,000/μL
Refractory anemia with excess blasts-2 (RAEB-2)	Cytopenias	Unilineage or multilineage dysplasia
	5% to 19% blasts	10% to 19% blasts
	Auer rods ±	Auer rods ±
	Monocytes <1,000/μL
MDS-unclassified (MDS-U)	Cytopenias	Unilineage dysplasia in granulocytes or megakaryocytes
	No or rare blasts	No Auer rods
	No Auer rods	<5% blasts
MDS with del (5q) “5q-syndrome”	Anemia	Normal to increased megakaryocytes with hypolobulated nuclei
	<5% blasts	No Auer rods
	Platelets usually normal or increased	<5% blasts Isolated del (5q)

Table 2 International Prognostic Scoring System (IPSS)⁷

Factor	Value	IPSS score	Notes
Blasts	5% or less	0
	5% to 10%	0.5
	11% to 20%	1.5
	21% to 30%	2.0
Cytogenetics	= Good	0	Normal; -Y only; 5q- only; or 20q- only
	= Intermediate	0.5	Abnormalities other than good or poor
	= Poor	1.0	Complex; 3 or more abnormalities or abnormal chromosome 7
Cytopenias	0/1	0	Hemoglobin <10 g/dL; absolute neutrophil count (ANC) <1,500/μL; platelet count <100,000/μL; each count as a value of 1.
	2/3	0.5

Notes: The numeric scores for the blast %, the cytogenetic changes and the cytopenias are combined to give the total numeric score. The scores equal a risk category:

• Low.

• Intermediate-1.

• Intermediate-2.

• High.

The risk categories are sometimes combined as

• Low and intermediate-1 = low-risk MDS.

• Intermediate-2 and high = high-risk MDS.

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