268 - MDS (Myelodysplastic Syndromes)

Question 1

What is the key finding on bone marrow biopsy in MDS?

Answer 1

Dysplasia

• Hypercellular
• Erythroid hyperplasia (increased precursors that are dysplastic)
• Granulocyte dysplasia
• Dysplastic megakaryocytes

Dysplasia can look like:

• Nuclear budding
• Intracellular bridging
• Multinucleation
• Bizzare nuclei

Question 2

What are the most important prognostic factors for MDS? (2)

Answer 2

Blast count

Cytogenetic abnormalities

*Don’t need to memorize specific abnormalities

Question 3

Pts with MDS with which chromosomal abnormality can be treated with lenalidomide?

Answer 3

del (5q)

Question 4

What are the clinical features of MDS? (3)

Answer 4

Anemia

Neutropenia

Thrombocytopenia

Pts with MDS will always have cytopenia

*No organomegaly (vs. CML)

*Slow onset (vs. AML)

Question 5

Describe the general difference in the cells of origin of:

• CML:
• AML:
• MDS:

Answer 5

• CML: Neoplastic fully matured myeloid cells [chronic = long = mature]
  
  • <20% blasts in peripheral blood
• AML: Neoplastic myeloid precursors [acute = short/young = immature precursors]
  
  • ​>20% blasts in peripheral blood
• MDS: abnormal cells across myeloid lines
  
  • ​Cytopenia
  • <20% peripheral blasts

MDS has a 10-40% chance of transforming to AML

Question 6

What are the major risk factors for MDS?

Answer 6

Benzene

Chemo

Radiation

Tobacco

Fanconi anemia

Dyskeratosis congenita

I think the bold ones were more emphasized in lecture

Question 7

What chromosomal abnormalities are associated with myelodysplastic sydrome?

Answer 7

Loss of part of 5

Loss of part of 7

11q23 deletion

In general, MDS has more gains or losses

(vs. leukemia has more translocations)
* Deletion of 5q has better prognosis*

Question 8

What qualifies as “MDS with excess blasts”?

Answer 8

5-19%

• MDS with excess blasts 1 = 5-9%
• MDS with excess blasts 2 = 10-19%

Poor prognosis in general :(

Note: >20% blasts is AML