Myelodysplastic Syndromes

The myelodysplastic syndromes (MDS) represent a group of syndromes having in common a defective production of one or more myeloid cell lines. They occur in patients which are more than 50 years old without any sex preponderance. The term MDS is replacing the obsolete and archaic term of 'preleukemia' and/or 'oligoblastic leukemia'. The more striking hematologic features are a discrepancy between a cellular bone marrow and a peripheral blood cytopenia. MDS may be idiopathic or secondary. Some of them precede or predispose to the subsequent development of an acute myeloid leukemia. A correct analysis of peripheral blood and bone marrow smears permits to classify MDS and to establish some prognostic features. Some syndromes are easily recognizable such as acquired idiopathic sideroblastic anemia, refractory anemia with excess of blasts, pure refractory cytopenia and acute myelodysplasia with myelofibrosis. Nevertheless this classification does not cover all these syndromes. Some of them with borderline features will be discussed separately. An analysis of a large series of MDS recently published in the literature will be presented as well as nosologic problems which arise. A conceptual effort should be made to recognize and evaluate the MDS.