268 - MDS (Myelodysplastic Syndromes) Flashcards
What is the key finding on bone marrow biopsy in MDS?
Dysplasia
- Hypercellular
- Erythroid hyperplasia (increased precursors that are dysplastic)
- Granulocyte dysplasia
- Dysplastic megakaryocytes
Dysplasia can look like:
- Nuclear budding
- Intracellular bridging
- Multinucleation
- Bizzare nuclei
What are the most important prognostic factors for MDS? (2)
Blast count
Cytogenetic abnormalities
*Don’t need to memorize specific abnormalities
Pts with MDS with which chromosomal abnormality can be treated with lenalidomide?
del (5q)
What are the clinical features of MDS? (3)
Anemia
Neutropenia
Thrombocytopenia
Pts with MDS will always have cytopenia
*No organomegaly (vs. CML)
*Slow onset (vs. AML)
Describe the general difference in the cells of origin of:
- CML:
- AML:
- MDS:
- CML: Neoplastic fully matured myeloid cells
- <20% blasts in peripheral blood
- AML: Neoplastic myeloid 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
What are the major risk factors for MDS?
Benzene
Chemo
Radiation
Tobacco
Fanconi anemia
Dyskeratosis congenita
I think the bold ones were more emphasized in lecture
What chromosomal abnormalities are associated with myelodysplastic sydrome?
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*
What qualifies as “MDS with excess blasts”?
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