{"id":1605,"date":"2026-03-14T12:43:19","date_gmt":"2026-03-14T12:43:19","guid":{"rendered":"https:\/\/blooducation.co.uk\/?p=1605"},"modified":"2026-03-14T12:43:30","modified_gmt":"2026-03-14T12:43:30","slug":"advances-in-the-classification-and-management-of-myelodysplasia-dr-manoj-raghavan","status":"publish","type":"post","link":"https:\/\/blooducation.co.uk\/advances-in-the-classification-and-management-of-myelodysplasia-dr-manoj-raghavan","title":{"rendered":"Advances in the classification and management of myelodysplasia &#8211; Dr Manoj Raghavan"},"content":{"rendered":"\n<p><strong>Dr Manoj Raghavan speaks to Suzy about the 2016 revised WHO classification of MDS and gives some hints about what is likely to be coming in the revised BSH guideline.<\/strong><\/p>\n\n\n<p><iframe style=\"border: none;\" src=\"\/\/html5-player.libsyn.com\/embed\/episode\/id\/11980361\/height\/90\/theme\/custom\/thumbnail\/no\/direction\/backward\/render-playlist\/no\/custom-color\/87A93A\/\" width=\"100%\" height=\"90\" scrolling=\"no\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>\u00a0<\/p>\n\n\n<figure class=\"wp-block-image size-full is-resized\"><img fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"676\" src=\"https:\/\/blooducation.co.uk\/wp-content\/uploads\/2030\/11\/manoj.jpg\" alt=\"\" class=\"wp-image-1105\" style=\"aspect-ratio:1.1834490045868256;width:495px;height:auto\" srcset=\"https:\/\/blooducation.co.uk\/wp-content\/uploads\/2030\/11\/manoj.jpg 800w, https:\/\/blooducation.co.uk\/wp-content\/uploads\/2030\/11\/manoj-300x254.jpg 300w, https:\/\/blooducation.co.uk\/wp-content\/uploads\/2030\/11\/manoj-768x649.jpg 768w, https:\/\/blooducation.co.uk\/wp-content\/uploads\/2030\/11\/manoj-70x60.jpg 70w, https:\/\/blooducation.co.uk\/wp-content\/uploads\/2030\/11\/manoj-20x16.jpg 20w, https:\/\/blooducation.co.uk\/wp-content\/uploads\/2030\/11\/manoj-150x127.jpg 150w, https:\/\/blooducation.co.uk\/wp-content\/uploads\/2030\/11\/manoj-600x507.jpg 600w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><\/figure>\n\n\n\n<p><strong>Classification<\/strong> \u2013 see link below for full definitions.<\/p>\n\n\n\n<p>Cytopenias defined as haemoglobin &lt;100g\/L, platelet count &lt;100 x10<sup>9<\/sup>\/L, neutrophils &lt;1.8 x10<sup>9<\/sup>\/L. These differ to the cytopenia thresholds in the IPSS-R.<\/p>\n\n\n\n<p>&#8211;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; MDS with single or multilineage dysplasia (MDS-SLD; MDS-MLD)<\/p>\n\n\n\n<p>&#8211;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; MDS with ringed sideroblasts with single or multilineage dysplasia or isolated del(5q) (MDS-RS-SLD; MDS-RS-MLD; MDS with isolated del(5q))<\/p>\n\n\n\n<p>&#8211;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; MDS with excess blasts 1 or 2 (MDS-EB-1; MDS-EB-2)<\/p>\n\n\n\n<p>&#8211;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; MDS unclassifiable (1% blood blasts; SLD and pancytopenia; based on defining cytogenetic abnormality; refractory cytopenia of childhood)<\/p>\n\n\n\n<p>MDS defining cytogenetic abnormalities (no change from 2008 classification) whereby MDS may be diagnosed even in the absence of diagnostic morphological dysplasia.<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><td><strong>Unbalanced abnormalities&nbsp;<\/strong><\/td><td><strong>Balanced abnormalities&nbsp;<\/strong><\/td><\/tr><\/thead><tbody><tr><td>\u22127 or del(7q)<\/td><td>t(11;16)(q23;p13.3)<\/td><\/tr><tr><td>\u22125 or del(5q)<\/td><td>t(3;21)(q26.2;q22.1)<\/td><\/tr><tr><td>i(17q) or t(17p)<\/td><td>t(1;3)(p36.3;q21.1)<\/td><\/tr><tr><td>\u221213 or del(13q)<\/td><td>t(2;11)(p21;q23)<\/td><\/tr><tr><td>del(11q)<\/td><td>inv(3)(q21q26.2)<\/td><\/tr><tr><td>del(12p) or t(12p)<\/td><td>t(6;9)(p23;q34)<\/td><\/tr><tr><td>del(9q)<\/td><td>&nbsp;<\/td><\/tr><tr><td>idic(X)(q13)<\/td><td>&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p>Complex = 3 or more of the above<\/p>\n\n\n\n<p>SF3B1 mutation in MDS-RS only require 5% RS to make a diagnosis; prognosis is better. DNMT3A, ASXL1, TET2 lower risk of progression and commonly found with ageing; P53 higher risk of progression.<\/p>\n\n\n\n<p>MDS mimics include haematinic deficiencies, other nutritional deficiencies e.g. zinc, copper, increased cell turnover for other reasons e.g. immune cytopenias, drug effects e.g. methotrexate, HIV.<\/p>\n\n\n\n<p>Generally a diagnosis requires cytopenias and dysplasia in at least one lineage involving &gt;10% cells with evidence of clonality (see full classification for complete diagnostic criteria)<\/p>\n\n\n\n<p>ICUS \u2013 idiopathic cytopenia of indeterminate significance &#8211; cytopenias, insufficient dysplasia to diagnose MDS and insufficient evidence of clonality (i.e. diagnostic criteria for other diagnoses not met)<\/p>\n\n\n\n<p>CCUS \u2013 clonal cytopenia of indeterminate significance&nbsp; &#8211; cytopenias with evidence of clonality, but insufficient dysplasia to diagnose MDS<\/p>\n\n\n\n<p>CHIP \u2013 clonal haematopoiesis of indeterminate potential \u2013 evidence of clonality in the absence of cytopenias and dysplasia<\/p>\n\n\n\n<p><strong>Diagnostic tests<\/strong><\/p>\n\n\n\n<p>G (giemsa) banding \u2013 looking at chromosomes to assess for translocations\/missing material<\/p>\n\n\n\n<p>FISH (fluorescence in situ hybridisation) \u2013 looks for specific additions\/losses<\/p>\n\n\n\n<p>DNA panels \u2013 look at more or fewer copy numbers at particular loci indicating losses or gains of parts of chromosomes. May be done by SNP (single nucleotide polymorphism) arrays. Won\u2019t identify balanced translocations, as DNA quantity will be the same. However in MDS these are rare. Can be done on peripheral blood (although the sensitivity will be lower than when done on marrow).<\/p>\n\n\n\n<p><strong>Treatment<\/strong><\/p>\n\n\n\n<p>Need to weigh risks of treatment against the life expectancy for individual patients. IPSS and IPSS-R based on blasts, cytogenetics and cytopenias help stratify into risk groups (link below).<\/p>\n\n\n\n<p><strong>Supportive care:<\/strong><\/p>\n\n\n\n<p>Red cell transfusion support guided by quality of life and symptoms, individualised. Swings in haemoglobin may be more important than the value of the haemoglobin. Rh and K matched<\/p>\n\n\n\n<p>Iron chelation: consider in younger patients with low risk disease and long life expectancy. Risk of liver and renal side effects. TELESTO trial \u2013 desferasirox (Exjade)<\/p>\n\n\n\n<p>Platelet support \u2013 generally for bleeding\/symptoms. tPO mimetics may reduce bleeding risk without improving mortality. Concerns regarding risk of fibrosis have been largely disbanded.<\/p>\n\n\n\n<p>Neutropenia \u2013 PRN GCSF for infections.<\/p>\n\n\n\n<p><strong>Chemotherapy:<\/strong><\/p>\n\n\n\n<p>Azacitidine is the only licensed treatment for patients not fit for induction chemo\/HSCT for those with 10-30% blasts. AZA001 study: Best supportive care or chemotherapy vs azacitidine. 2.5y OS with aza vs 1.5y for other treatments. Median survival 18m in patients on azacitidine in real life studies. Given as OP, tolerated well even in older patients.<\/p>\n\n\n\n<p>High risk patients suitable for transplant: aim to get blast count &lt;10% prior to HSCT. Induction chemotherapy is with AML agents.<\/p>\n\n\n\n<p>MDS with del(5q) \u2013 treat with epo or if unsuccessful lenalidomide, which can induce cytogenetic remissions and reduce transfusion dependence. May select out TP53 mutations. Good prognosis if isolated del(5q) (NB lenalidomide only licensed in patients with isolated del(5q)).<\/p>\n\n\n\n<p><strong>Useful links<\/strong><\/p>\n\n\n\n<p><a href=\"https:\/\/ashpublications.org\/blood\/article\/127\/20\/2391\/35255\/The-2016-revision-to-the-World-Health-Organization\">2016 revision of WHO classification of haematological malignancies (including MDS)<\/a><\/p>\n\n\n\n<p><a href=\"http:\/\/www.bloodjournal.org\/blood\/article-abstract\/132\/Supplement%201\/234\/261970\/Safety-and-Efficacy-Including-Event-Free-Survival?redirectedFrom=fulltext\">ASH abstract 2018: TELESTO study<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/ashpublications.org\/blood\/article\/126\/23\/2862\/135411\/Biomarkers-of-Ineffective-Erythropoiesis-Predict\">ASH abstract 2018: Luspatercept in MDS<\/a><\/p>\n\n\n\n<p><a href=\"http:\/\/www.ukmdsforum.org.uk\/prognostic-scores\/ipss-and-ipss-r-calculator\">Prognostic scoring<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Dr Manoj Raghavan speaks to Suzy about the 2016 revised WHO classification of MDS and gives some hints about what is likely to be coming in the revised BSH guideline. \u00a0 Classification \u2013 see link below for full definitions. Cytopenias defined as haemoglobin &lt;100g\/L, platelet count &lt;100 x109\/L, neutrophils &lt;1.8 x109\/L. These differ to the [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":1104,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[158],"tags":[103,132,125,124,136,123],"class_list":["post-1605","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-podcast","tag-blood","tag-blooducation","tag-foamed","tag-nhs","tag-podcast","tag-podcasts"],"_links":{"self":[{"href":"https:\/\/blooducation.co.uk\/api\/wp\/v2\/posts\/1605","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blooducation.co.uk\/api\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blooducation.co.uk\/api\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blooducation.co.uk\/api\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blooducation.co.uk\/api\/wp\/v2\/comments?post=1605"}],"version-history":[{"count":1,"href":"https:\/\/blooducation.co.uk\/api\/wp\/v2\/posts\/1605\/revisions"}],"predecessor-version":[{"id":1606,"href":"https:\/\/blooducation.co.uk\/api\/wp\/v2\/posts\/1605\/revisions\/1606"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blooducation.co.uk\/api\/wp\/v2\/media\/1104"}],"wp:attachment":[{"href":"https:\/\/blooducation.co.uk\/api\/wp\/v2\/media?parent=1605"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blooducation.co.uk\/api\/wp\/v2\/categories?post=1605"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blooducation.co.uk\/api\/wp\/v2\/tags?post=1605"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}