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Sharathkumar A, Carr J, Claassen D, Syrbu S, Bhagavathi S, Al-Huniti A, Modi A, Bates M, Mott SL. Romiplostim for Treatment of Children and Young Adults With Severe Aplastic Anemia and Myelodysplastic Syndrome. J Pediatr Hematol Oncol 2024:00043426-990000000-00424. [PMID: 38787686 DOI: 10.1097/mph.0000000000002891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
Thrombopoietin receptor agonists (TPO-RAs) induce trilineage hematopoiesis under conditions with acquired hematopoietic failure. We evaluated safety, tolerability, and preliminary efficacy of a TPO-RA, romiplostim (Nplate), with or without standard-of-care immunosuppressive therapy (±IST) for children (ages <21 y) with newly diagnosed and relapsed/refractory severe aplastic anemia (SAA) and myelodysplastic syndrome (MDS). Data were collected from an observational study and a single arm interventional pilot study. The safety outcome was treatment-related adverse events (AEs). Efficacy was evaluated by complete hematopoietic response (CHR) at week 24. Romiplostim was commenced at 5 µg/kg/week, with dose escalation of 2.5 µg/kg/week (maximum, 20 µg/kg/dose) based on platelet response. Romiplostim was continued until CHR was observed. Ten subjects (SAA, 9 [IST, 4; without IST, 5]; MDS, 1) completed the study (median age: 9.2 y). Median romiplostim dose was 10 µg/kg/week (range: 5 to 17.5 µg/kg/week). The cumulative incidence of CHR was 70.4% (95% CI, 20.2%-92.6%). Among 21 AEs (Grade 1 to 3), 3 were attributed to romiplostim. At a median posttherapy follow-up of 10.9 months (range: 0.7 to 77.5), no clonal evolution, bone marrow fibrosis or mortality was reported. This proof-of-concept study provides data about short-term safety, tolerability, and preliminary efficacy of romiplostim (±IST) for treatment of pediatric SAA/MDS.
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Affiliation(s)
- Anjali Sharathkumar
- Stead Family Department of Pediatrics, Carver College of Medicine
- Holden Comprehensive Cancer Center
| | - Jamie Carr
- Institute for Clinical and Translational Science
| | - David Claassen
- Stead Family Department of Pediatrics, Carver College of Medicine
| | - Sergei Syrbu
- Department of Pathology, University of Iowa, Iowa City, IA
| | | | - Ahmad Al-Huniti
- Department of Pediatrics, Mayo Clinic, Hematology, Rochester, MN
| | - Arunkumar Modi
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Melissa Bates
- Holden Comprehensive Cancer Center
- Department of Health and Human Physiology
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA
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Pezeshki A, Podder S, Kamel R, Corey SJ. Monosomy 7/del (7q) in inherited bone marrow failure syndromes: A systematic review. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26714. [PMID: 28708320 PMCID: PMC5937691 DOI: 10.1002/pbc.26714] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 11/08/2022]
Abstract
Inherited bone marrow failure syndromes (IBMFS) are rare cancer predisposition syndromes with an especially high risk of transformation to myelodysplastic syndrome (MDS) and/or acute myeloid leukemia (AML). We performed a retrospective systematic review of reported MDS/AML arising in the eight most common IBMFS to determine the frequency and outcome of chromosome 7 abnormalities. We identified 738 MDS/AML cases of 4,293 individuals. Monosomy 7 or del (7q) occurred in ∼17%. Greater understanding of the roles played by sequential acquisition of genetic and cytogenetic changes will provide insights into myeloid leukemogenesis and improve the surveillance and hopefully outcomes for individuals with IBMFS.
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Affiliation(s)
- Alex Pezeshki
- Wayne State University School of Medicine, Detroit, Michigan
| | - Shreya Podder
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Children’s Hospital of Richmond and Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Ralph Kamel
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Children’s Hospital of Richmond and Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Seth J. Corey
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Children’s Hospital of Richmond and Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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Waespe N, Van Den Akker M, Klaassen RJ, Lieberman L, Irwin MS, Ali SS, Abdelhaleem M, Zlateska B, Liebman M, Cada M, Schechter T, Dror Y. Response to treatment with azacitidine in children with advanced myelodysplastic syndrome prior to hematopoietic stem cell transplantation. Haematologica 2016; 101:1508-1515. [PMID: 27540140 DOI: 10.3324/haematol.2016.145821] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/18/2016] [Indexed: 12/14/2022] Open
Abstract
Advanced myelodysplastic syndrome harbors a high risk of progression to acute myeloid leukemia and poor prognosis. In children, there is no established treatment to prevent or delay progression to leukemia prior to hematopoietic stem cell transplantation. Azacitidine is a hypomethylating agent, which was shown to slow progression to leukemia in adults with myelodysplastic syndrome. There is little data on the efficacy of azacitidine in children. We reviewed 22 pediatric patients with advanced myelodysplastic syndrome from a single center, diagnosed between January 2000 and December 2015. Of those, eight patients received off-label azacitidine before hematopoietic stem cell transplantation. A total of 31 cycles were administered and modification or delay occurred in four of them due to cytopenias, infection, nausea/vomiting, and transient renal impairment. Bone marrow blast percentages in azacitidine-treated patients decreased significantly from a median of 15% (range 9-31%) at the start of treatment to 5.5% (0-12%, P=0.02) before hematopoietic stem cell transplantation. Following azacitidine treatment, four patients (50%) achieved marrow remission, and none progressed. In contrast, three untreated patients (21.4%) had progressive disease characterized by >50% increase in blast counts or progression to leukemia. Azacitidine-treated patients had significantly increased 4-year event-free survival (P=0.04); predicted 4-year overall survival was 100% versus 69.3% in untreated patients (P=0.1). In summary, azacitidine treatment prior to hematopoietic stem cell transplantation was well tolerated in pediatric patients with advanced myelodysplastic syndrome, led to partial or complete bone marrow response in seven of eight patients (87.5%), and correlated with superior event-free survival in this cohort.
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Affiliation(s)
- Nicolas Waespe
- Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada.,Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
| | - Machiel Van Den Akker
- Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada.,Pediatric Hematology/Oncology, UZ Brussel, Jette, Belgium
| | - Robert J Klaassen
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Lani Lieberman
- Department of Laboratory Medicine, University Health Network, Toronto, Canada
| | - Meredith S Irwin
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Salah S Ali
- Bone Marrow Transplantation Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Mohamed Abdelhaleem
- Department of Pediatric Laboratory Medicine, Division of Hematopathology, The Hospital for Sick Children, Toronto, Canada
| | - Bozana Zlateska
- Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada.,Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
| | - Mira Liebman
- Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Michaela Cada
- Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Tal Schechter
- Bone Marrow Transplantation Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Yigal Dror
- Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada .,Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada.,Institute of Medical Science, University of Toronto, Canada
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Moriwaki K, Manabe A, Taketani T, Kikuchi A, Nakahata T, Hayashi Y. Cytogenetics and clinical features of pediatric myelodysplastic syndrome in Japan. Int J Hematol 2014; 100:478-84. [PMID: 25261124 DOI: 10.1007/s12185-014-1674-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 09/08/2014] [Accepted: 09/08/2014] [Indexed: 11/26/2022]
Abstract
We analyzed the cytogenetics and clinical features of pediatric myelodysplastic syndrome (MDS) in Japan. Data on patients (<16 years) diagnosed with MDS from 1990 to 2000 were retrospectively collected from pediatric hematologists in 234 institutions. Chromosome analysis was successfully performed in 255 of 277 MDS patients. The numbers of patients with refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess of blasts (RAEB), refractory anemia with excess of blasts in transformation (RAEBt), chronic myelomonocytic leukemia, and juvenile myelomonocytic leukemia were 67 (24%), 51 (18%), 51 (18%), 20 (7%), and 65 (23%), respectively. The other 23 patients (8%) could not be classified specifically. The distribution of childhood MDS in Japan according to the French-American-British subclassification was similar to that in other countries. However, we identified a higher incidence of therapy-related cases. As for relationship between cytogenetics and prognoses, abnormal karyotypes were related to poorer prognoses than normal karyotype (P < 0.01). However, patients with trisomy 8 had prognoses comparable to those with normal karyotypes. Complex karyotypes were associated with poorer prognoses among RAEB and RAEBt patients. In conclusion, prognosis of pediatric MDS is related to cytogenetics. A more precise diagnosis and classification system is needed for childhood MDS.
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Affiliation(s)
- Koichi Moriwaki
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Chatterjee T, Mahapatra M, Dixit A, Naithani R, Tyagi S, Mishra P, Bhattacharya J, Dutta P, Pati HP, Choudhary DR, Kumar R, Choudhry VP, Saxena R. Primary myelodysplastic syndrome in children—clinical, hematological and histomorphological profile from a tertiary care centre in India. Hematology 2013; 10:495-9. [PMID: 16321814 DOI: 10.1080/10245330500155556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
We describe the clinical, hematological and histomorphological features in children of primary myelodysplastic syndrome (MDS) seen at the All India Institute of Medical Sciences over three years (Jan 2001-Jan 2004). Twenty-one patients of primary MDS aged 17 year or less were classified using the latest proposed WHO classification for Pediatric MDS. The median age was 9 years with male predominance (80%). Pallor was present in all the cases while fever and bleeding diathesis was present in more than 50% of the cases. Morphological assessment of the peripheral blood showed macrocytosis in 50%, pancytopenia in 15% and blast cells in 45% of cases. A complete analysis of clinical features in conjunction with the bone marrow profile revealed 8 cases of refractory cytopenia (RC), 3 cases of refractory anemia with excess blasts (RAEB), 5 cases of refractory anemia with excess blasts in transformation (RAEB-T), 4 cases of Juvenile myelomonocytic leukemia (JMML) and a solitary cases of acute myeloid leukemia (AML) in Downs syndrome. These children were followed up from 1-36 months (mean 15 months). Three patients of RAEB-T progressed to AML within 3-4 months. RC had the best prognosis and all are alive and under regular follow up. The solitary case of AML of Downs syndrome died 1.5 months after initial diagnosis. All 3 cases of RAEB are under regular follow-up and doing well. Three cases of RAEB-T died (all had progressed to AML); the remaining 2 cases were lost to follow up. Of the 4 cases of JMML 1 died within 6 months of diagnosis; the other 3 cases are under regular follow up of whom 1 has a progressively increasing blast count. We conclude that the latest proposed WHO classification for Pediatric MDS can be successfully applied to all cases of primary MDS.
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Affiliation(s)
- Tathagata Chatterjee
- All India Institute of Medical Sciences, Department of Hematology, New Delhi, 110029, India
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Tilak V, Sookmane DD, Gupta V, Shukla J. Myelodysplastic syndrome. Indian J Pediatr 2008; 75:729-32. [PMID: 18716744 DOI: 10.1007/s12098-008-0138-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 05/27/2008] [Indexed: 11/28/2022]
Abstract
Pediatric myelodysplastic syndrome (MDS), though rare, constitutes a distinct entity quite different from adult MDS. They have unique clinical features, aggressive clinical course with an overall mean survival of only 9.9 months. A pediatric approach to the WHO classification has become necessary since the WHO classification of MDS has failed to address the uniqueness of pediatric MDS. A new prognostic system also needs to be evolved since the international prognostic system has limited prognostic impact in children. Intensive chemotherapy such as the one used in de novo-acute myeloid leukemia (AML) leads to complete remission in some children and this may be the treatment of choice in pediatric MDS.
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Affiliation(s)
- V Tilak
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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Niemeyer CM, Kratz CP. Paediatric myelodysplastic syndromes and juvenile myelomonocytic leukaemia: molecular classification and treatment options. Br J Haematol 2008; 140:610-24. [DOI: 10.1111/j.1365-2141.2007.06958.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Cheong JW, Kook H, Bang SM, Lee JH, Joo YD, Kim I, Kim HJ, Park CJ, Park HJ, Ahn JS, Yoon SS, Won JH, Lee MH, Jung CW, Jo DY, Cho B, Han KJ, Min YH, Kim SH. The Clinical Guidelines for Myelodysplastic Syndrome. THE KOREAN JOURNAL OF HEMATOLOGY 2007. [DOI: 10.5045/kjh.2007.42.2.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- June-Won Cheong
- Department of Internal Meidicine, Yonsei University College of Medicine, Korea
| | - Hoon Kook
- Department of Pediatrics, Hwasun Hospital, Chonnam National University Medical School, Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Bundang Hospital, Seoul National University College of Medicine, Korea
| | - Je Hwan Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Yong-Don Joo
- Department of Internal Medicine, Busan Paik Hospital, College of Medicine, Inje University, Korea
| | - Inho Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Korea
| | - Hyeoung Joon Kim
- Department of Hematology-Oncology, Hwasun Hospital, Chonnam National University Medical School, Korea
| | - Chan-Jeoung Park
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Hyeon-Jin Park
- Pediatric Oncology Branch, Specific Organs Cancer Center, National Cancer Center, Korea
| | - Jin Seok Ahn
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Korea
| | - Jong-Ho Won
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Korea
| | - Mark Hong Lee
- Department of Internal Medicine, Konkuk University College of Medicine, Korea
| | - Chul Won Jung
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Korea
| | - Deog-Yeon Jo
- Department of Internal Medicine, Chungnam National University College of Medicine, Korea
| | - Bin Cho
- Department of Pediatrics, St. Mary's Hospital, The Catholic University of Korea College of Medicine, Korea
| | - Kyoung Ja Han
- Department of Laboratory Medicine, St. Mary's Hospital, The Catholic University of Korea College of Medicine, Korea
| | - Yoo Hong Min
- Department of Internal Meidicine, Yonsei University College of Medicine, Korea
| | - Sun Hee Kim
- Department of Laboratory Medicine, Sungkyunkwan University School of Medicine, Korea
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Irons RD, Wang X, Gross SA, Bao L, Ryder J, Chen Y, Chen H, Sun H, Zhou J, Ji M, Du X, Fu H, Lin G. Prevalence of MDS subtypes in Shanghai, China: a comparison of the World Health Organization and French American British classifications. Leuk Res 2005; 30:769-75. [PMID: 16337268 DOI: 10.1016/j.leukres.2005.10.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2005] [Revised: 10/18/2005] [Accepted: 10/21/2005] [Indexed: 10/25/2022]
Abstract
The prevalence of subtypes of the myelodysplastic syndromes (MDS) was determined in a prospective series of 176 patients presenting at 28 Shanghai hospitals. Diagnosis was established in a single laboratory, analyzing morphologic, immunophenotypic, and cytogenetic data, using the World Health Organization (WHO) revised classification and directly compared to the French American British (FAB) criteria. The median age at diagnosis for all cases was 53 years. There was a striking increase in the prevalence of RCMD in younger patients relative to other subtypes (WHO). The overall frequency of clonal cytogenetic abnormalities was 26.5% (WHO) and 31% (FAB). The most frequently encountered lesions were trisomy 8, del(20)q, del(7q), and del(5q). These results are consistent with previously reported age-dependent differences in MDS and a decreased frequency of del(5q) abnormalities between China and the West. These results also indicate that multilineage dysplasia is a prominent feature in MDS developing in younger individuals in Shanghai and suggest distinguishing between RCMD and RA may be important in the design of studies to further understand regional differences in subtype prevalence and to elucidate the pathogenesis of this complex and multifactorial disease.
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Affiliation(s)
- Richard D Irons
- Sino-US Joint Clinical and Molecular Laboratory, Fudan University, Shanghai, China.
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Occhipinti E, Correa H, Yu L, Craver R. Comparison of two new classifications for pediatric myelodysplastic and myeloproliferative disorders. Pediatr Blood Cancer 2005; 44:240-4. [PMID: 15368549 DOI: 10.1002/pbc.20174] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The category, cytology, cytogenetics (CCC) system for myelodysplastic syndrome (MDS) and the pediatric WHO system for MDS/myeloproliferative disorder (MPD) have recently been proposed to characterize these diseases in pediatrics. OBJECTIVE We compare the CCC and pediatric WHO systems against each other and against the French, American, British (FAB) and adult WHO classifications in order to determine which more accurately classifies these diseases and predicts outcome. METHODS An 18-year retrospective review identified patients less than 18 years of age meeting CCC and/or pediatric WHO criteria for the diagnosis of MDS or MPD. Resolution, stability, progression, and death in the subcategories of each system were compared. RESULTS Twenty-eight patients were included in the study. Pediatric WHO: 17 patients met criteria, 10 died. Eight developed acute myelogenous leukemia (AML) (seven died), one juvenile myelomonocytic leukemia (JMML) (died), one chronic myelomonocytic leukemia (CMML) (currently in relapse), two died of complications, two responded to BMT, three have stable disease, one resolved. Eleven patients were not classifiable by the pediatric WHO system, one of which progressed to AML and died. CCC: 26 patients met criteria, 9 died. Nine developed AML (8 died), 1 died of complications, 10 responded to treatment (BMT and/or chemotherapy). Four are stable without treatment, two resolved. Two patients with MPD were not classifiable by the CCC system. CONCLUSIONS Both the pediatric WHO and CCC systems are better able to classify MDS in children than the adult WHO and FAB classifications. The pediatric WHO system is more exclusive. Children meeting these criteria are more likely to progress to AML or death. The restrictive nature of the pediatric WHO system was unable to classify one case of fatal MDS. The CCC system is more inclusive and can stratify patients into a neutral or poor prognosis based upon outcome. However, the CCC system ignores those diseases with a myeloprolifferative component. This resulted in two cases of MPD that were unclassifiable by the CCC system. One of these patients died, the other is currently in relapse.
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Affiliation(s)
- Elise Occhipinti
- Department of Pathology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
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Hasle H, Niemeyer CM, Chessells JM, Baumann I, Bennett JM, Kerndrup G, Head DR. A pediatric approach to the WHO classification of myelodysplastic and myeloproliferative diseases. Leukemia 2003; 17:277-82. [PMID: 12592323 DOI: 10.1038/sj.leu.2402765] [Citation(s) in RCA: 255] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2002] [Accepted: 08/07/2002] [Indexed: 11/08/2022]
Abstract
Myelodysplastic and myeloproliferative disorders are rare in childhood and there is no widely accepted system for their diagnosis and classification. We propose minimal diagnostic criteria and a simple classification scheme which, while based on accepted morphological features and conforming with the recent suggestions of the WHO, allows for the special problems of myelodysplastic diseases in children. The classification recognizes three major diagnostic groups: (1) juvenile myelomonocytic leukemia (JMML), previously named chronic myelomonocytic leukemia (CMML) or juvenile chronic myeloid leukemia (JCML); (2) myeloid leukemia of Down syndrome, a disease with distinct clinical and biological features, encompassing both MDS and AML occurring in Down syndrome; and (3) MDS occurring both de novo and as a complication of previous therapy or pre-existing bone marrow disorder (secondary MDS). The main subtypes of MDS are refractory cytopenia (RC) and refractory anemia with excess of blasts (RAEB). It is suggested retaining the subtype of RAEB-T with 20-30% blasts in the marrow until more data are available. Cytogenetics and serial assessments of the patients are essential adjuncts to morphology both in diagnosis and classification.
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Affiliation(s)
- H Hasle
- Department of Pediatrics, Skejby Hospital, Aarhus, Denmark.
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