What is the benefit of the WHO classification system in the diagnosis of myelodysplastic syndrome (MDS)?

Updated: Jul 24, 2018
  • Author: Emmanuel C Besa, MD; Chief Editor: Koyamangalath Krishnan, MD, FRCP, FACP  more...
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Answer

The WHO classification is helpful in predicting subgroup differences in prognosis and response to treatment in patients with MDS. Refractory cytopenias are divided into those in which multi-lineage dysplasia is absent (RCMD-) or present (RCMD+) and those with ringed sideroblasts (RCMD+/+RS) or without ringed sideroblasts (RCMD/-RS).

A new subcategory includes patients with isolated deletion of chromosome 5q (5q-) and less than 5% blasts, called the 5q- syndrome. [19] Identification of the syndrome or presence of this particular cytogenetic abnormality is useful because the majority of these patients will respond to treatment with lenalidomide (Revlimid).

Unclassified by the WHO are the group of patients with MDS whose conditions overlap with severe aplastic anemia and paroxysmal nocturnal hemoglobinuria. This group includes MDS patients with the FAB-RA subtype who may have a hypoplastic marrow, usually have a human leukocyte antigen (HLA)-DR15 phenotype, are young (< 60 years), may have cells deficient in CD55 and CD59, and respond to immunosuppressive treatment with anti-thymocyte globulin (ATG) or cyclosporin. [20]


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