Myelodysplastic syndrome classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]

Overview

Myelodysplastic syndrome may be classified into several subtypes based on the French-American-British (FAB) classification and World Health Organization the (WHO) classification methods.

Classification

French-American-British (FAB) Classification

• Myelodysplastic syndrome may be classified according to the French-American-British classification into five groups: Refractory anemia, refractory anemia with ring sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, and chronic myelomonocytic leukemia.
• The table below lists FAB classification for myelodysplastic syndrome:

Name	Description
Refractory anemia	Less than 5% primitive blood cells (myeloblasts) in the bone marrow and pathological abnormalities primarily seen in red blood cell precursors.
Refractory anemia with ring sideroblasts (RARS)	Less than 5% myeloblasts in the bone marrow, but distinguished by the presence of ringed sideroblasts which may compose greater than 15% of red blood cell precursor in the marrow.
Refractory anemia with excess blasts (RAEB)	5-20% myeloblasts in the marrow
Refractory anemia with excess blasts in transformation (RAEB-T)	21-30% myeloblasts in the marrow (>30% blasts is defined as acute myeloid leukemia)
Chronic myelomonocytic leukemia (CMML)	Less than 20% myeloblasts in the bone marrow and greater than 1*109/L monocytes in peripheral blood

WHO Classification

• Myelodysplastic syndromes may be classified according to the WHO classification method into eight subtypes: Refractory anemia, refractory cytopenia with unilineage dysplasia, refractory anemia with ring sideroblasts, refractory cytopenia with multilineage dysplasia, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, refractory cytopenia of childhood, and unclassifiable myelodysplastic syndrome.
• The table below lists World Health Organiztion classification for myelodysplastic syndrome:

Old system	New system
Refractory anemia	Refractory cytopenia with unilineage dysplasia
Refractory anemia with ringed sideroblasts	Refractory anemia with ring sideroblasts
	Refractory cytopenia with multilineage dysplasia
Refractory anemia with excess blasts	Refractory anemias with excess blasts I and II
Refractory anemia with excess blasts in transformation I–IV	5q - syndrome
Chronic myelomonocytic leukemia	Myelodysplastic-myeloproliferative overlap syndromes
	Refractory cytopenia of childhood
	Unclassifiable myelodysplastic syndrome

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