Importantly, these studies have shown that there is no differences in median survival among patients classified into the different WHO subgroups of de novo MDS nor their bone marrow blast percentage correlate with the uniformly poor outcome in t-MDS regardless of morphologic subclassification. ![]() ![]() In the recent studies of a large group of patients with t-MDS and t-AML at the University of Chicago (Am J Clin Path 2007 127:1970295), the patients with t-MDS could be categorized according to WHO criteria for de novo MDS as RA, RCMD, RCMD RS, RAEB1 and RAB2, with most patients falling into the RCMD category. T-MDS can fall into different morphologic categories, when applying WHO criteria for de novo MDS. The megakaryocytes in t-MDS can show particularly marked pleomorphism with both small dwarf dysplastic megakaryocytes as well as large atypical forms. The number of blasts in t-MDS can be variable, and the blasts can be CD34(+) or CD34(-) plus t- MDS is often associated with fibrosis. ![]() The clinical history of laryngeal carcinoma 7 years ago, short clinical evolution of bone marrow dysfunction, lack of splenomegaly, peripheral blood smear demonstrating leukopenia with left shift and 3% blasts, hyposegmentation, dyserythropoietic normocytes and thrombocytopenia, and bone marrow showing fibrosis, dysmegakaryopoiesis (large and medium sized dysplastic megakaryocytes), depressed granulopoiesis and erythropoiesis, with no appreciable increase in CD34/TdT/Bcl2/CD117+ blasts, CK-, are consistent with therapy related MDS with myelofibrosis.
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