NCCN Guidelines for Patients® | Myelodysplastic Syndromes

12 NCCN Guidelines for Patients ® : Myelodysplastic Syndromes, 2018 1 Myelodysplastic syndromes Symptoms of MDS MDS/MPN subtypes in the WHO classification system The MDS/MPN category includes subtypes that have both dysplastic and proliferative features. Dysplastic refers to the bone marrow making blood cells that look and act abnormal. Proliferative refers to the bone marrow making too many blood cells. The subtypes in the MDS/MPN category are described next. CMML-1 (chronic myelomonocytic leukemia-1) In this subtype, there is a high level of white blood cells called monocytes in the bloodstream. One or more types of blood cells in the bone marrow look abnormal (show dysplasia). Less than 5 percent of cells in the bloodstream are blast cells. Less than 10 percent of cells in the bone marrow are blast cells. CMML-2 (chronic myelomonocytic leukemia-2) In this subtype, there is a high level of monocytes in the bloodstream. One or more types of blood cells in the bone marrow look abnormal. In the bloodstream, 5 to 19 percent of cells are blast cells. In the bone marrow, 10 to 19 percent of cells are blast cells. Atypical CML (chronic myeloid leukemia), BCR-ABL1 negative In this subtype, there is a high level of white blood cells in the bloodstream. More than 10 percent of the cells are very young neutrophils. But, less than 20 percent of cells in the bloodstream are blast cells. There is a higher-than-normal number of blood cells in the bone marrow. Less than 20 percent of cells in the bone marrow are blasts. This subtype has cells that may look similar to CML when viewed with a microscope. But, the cells lack the chromosome and gene changes found in typical CML. The key changes in typical CML are the abnormal Philadelphia chromosome and the BCR-ABL1 gene. This subtype is not treated the same as typical CML. JMML (juvenile myelomonocytic leukemia) In this subtype, there is a high level of monocytes in the bloodstream and bone marrow. Less than 20 percent of cells in the bloodstream are blast cells. This subtype is a lot like CMML. The main difference is that JMML most often occurs in young children. MDS/MPN (MDS/myeloproliferative neoplasm), unclassifiable This subtype is also referred to as “Overlap syndrome.” There is a high level of one or more types of blood cells in the bloodstream and bone marrow. One or more types of blood cells also look abnormal. But, the features of the blood and bone marrow don’t fit any of the other MDS/MPN subtypes. MDS/MPN-RS-T (MDS/myeloproliferative neoplasm with ring sideroblast and thrombocytosis) In this subtype, there is a high level of one or more types of blood cells in the bloodstream and bone marrow. At least 15 percent of young red blood cells in the bone marrow are ringed sideroblasts along with a platelet count. Symptoms of MDS People with MDS often have low levels of one or more types of blood cells in their bloodstream. A low number of blood cells is called a cytopenia. Most symptoms of MDS are caused by not having enough healthy red blood cells, white blood cells, or platelets in the bloodstream.

RkJQdWJsaXNoZXIy MTE3MTE1