41. Myelodysplastic Syndromes myelodysplastic syndromes. 02/14/2000. Click here to start. Table of Contents. MyelodysplasticSyndromes Case Presentation. Case Presentation 1 cont’d. http://www.bcm.tmc.edu/medicine/hema-onco/lectures/mds/

Myelodysplastic Syndromes Click here to start Table of Contents Myelodysplastic Syndromes Case Presentation Case Presentation #1 - cont’d. Definition of Myelodysplasia ... Bone Marrow Transplantation in Myelodysplastic Syndrome Author: Dr. Kelty R. Baker Email: thayes@bcm.tmc.edu Home Page: http://www.bcm.tmc.edu/medicine/hema-onco Download Powerpoint File

42. Myelodysplastic Syndromes myelodysplastic syndromes. Kelty R. Baker, MD. Baylor College of Medicine. http://www.bcm.tmc.edu/medicine/hema-onco/lectures/mds/tsld001.htm

Myelodysplastic Syndromes Kelty R. Baker, M.D. Baylor College of Medicine Next slide Back to first slide View graphic version

43. NHLBI Workshop: Issues In Myelodysplastic Syndromes NHLBI Intramural/Extramural Workshop Critical Research Issues in MyelodysplasticSyndromes Friday April 30, 1999 Rockledge II Conference Rooms 91129116 Agenda http://www.nhlbi.nih.gov/meetings/workshops/myelodys.htm

NHLBI Intramural/Extramural Workshop Critical Research Issues in Myelodysplastic Syndromes Friday April 30, 1999 Rockledge II Conference Rooms 9112-9116 Agenda Each speaker is asked to briefly address the following questions: 1. What do we know? 2.What don’t we know but need to know? 3. Are there areas of reasonable doubt that require study? Scientific Organizing Committee Chair, Charles Peterson, National Heart, Lung, and Blood Institute, NIH Barbara Alving, National Heart, Lung, and Blood Institute, NIH Elaine Sloand, National Heart, Lung, and Blood Institute, NIH Neal Young, National Heart, Lung, and Blood Institute, NIH 9:00 AM Welcome from Intramural: N. Young 9:30 AM Diagnosis/Classification Chair: C. Peterson, National Heart, Lung, and Blood Institute, NIH Presenter: R. Larson (20 min) Discussant: J. Barrett (20 min) Open Discussion Chair’s Recommendations: Break 11:00 AM Molecular Mechanisms Chair: E. Sloand, National Heart, Lung, and Blood Institute, NIH Presenter: J. Barrett (20 min) Discussant: N. Young

44. LEUKEMIA: MYELODYSPLASTIC SYNDROMES Leukemia myelodysplastic syndromes. myelodysplastic syndromes are a diverse groupof closely related disorders characterized by ineffective hematopoiesis. http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/wcd/syndrome

Leukemia: Myelodysplastic Syndromes Myelodysplastic syndromes are a diverse group of closely related disorders characterized by ineffective hematopoiesis. The impaired production and maturation of hematopoietic is manifest by morphologic dysplasia (usually trilineage) in the erythroid ( dyserythropoiesis ), myeloid ( dysmyelopoiesis ) and megakaryocytic ( dysmegakaryocytopoiesis ) cell lines. The myelodysplastic syndromes (MDS) are neoplastic clonal stem cell proliferations which gradually replace the normal marrow elements. The MDS cells have been demonstrated to suppress normal marrow elements. MDS are sometimes referred to as smoldering leukemia, subacute leukemia, or preleukemia. Because of the spectrum of dysplasia the myelodysplastic syndromes have been divided into five subgroups shown on the next card. Second Year Medical Students should recognize the five syndromes (below) by name; know which are the most serious disorders, and appreciate the degree of dysplasia described by each. MDS Peripheral Blood Bone Marrow Refractory anemia (RA) Refractory anemia with ringed sideroblasts (RAS) Refractory anemia with excess blasts (RAEB) Chronic myelomonocytic leukemia (CMML) /L);

45. Myelodysplastic Syndromes A hypothesis for the pathogenesis of myelodysplastic syndromes implications fornew therapies C Rosenfeld A List Leukemia Normal and Malignant Hemopoiesis http://www.med.unipi.it/patchir/bloodl/bmr/hemat/mds.htm

Myelodysplastic sindromes A hypothesis for the pathogenesis of myelodysplastic syndromes: implications for new therapies Leukemia Normal and Malignant Hemopoiesis January 2000, Volume 14, Issue 1 The myelodysplastic syndromes consist of five separate entities, many of wich have overlapping characteristics that can be distinguished by the predominant blood and marrow characteristics: Refractory anemia (RA) Refractory anemia with ring sideroblasts ( RAS) Chronic myelomonocytic leukemia (CMML) Refractory anemia excess blasts (RAEB) Refractory anemia excess blasts in trasformation (RAEB-T) The most frequent presentationis is anemia . This anemia is characterized by hypoproliferation, with an increase in the mean cell volume. Neutropenia is often accompanied by a monocytosis. Thrombocytopenia is found in 25% of patients at the time of diagnsos, but mild thromobcytosis may also occur. The abnormality in platelets may be accompanied by abnormal platelet funcion . Often patients have lymphocyte abnormalities, such as lymphopenia with decreased numbers of natural killer cells and/or helper lymphocytes.

46. Myelodysplastic Syndromes Thrombotic Thrombocytopenic Purpura. Thrombotic thrombocytopenic purpura(TTP) is a devastating hematologic disorder clinically characterized http://www.med.unipi.it/patchir/bloodl/bmr/hemat/ttp.htm

Thrombotic Thrombocytopenic Purpura Thrombotic thrombocytopenic purpura (TTP) is a devastating hematologic disorder clinically characterized by the diagnostic pentad of: 1) severe microangiopathic hemolytic anemia associated with a very high serum lactic dehydrogenase (LDH) and a blood smear that typically shows schistocytes and helmet cells; thrombocytopenia which is moderate to severe and in which megakaryocytes are increased in the bone marrow and peripheral platelet survival is shortened; 3) fever , which is occasionally quite high; 4) central nervous system dysfunction that may begin with transient and intermitten signs and symptoms which include agitation, headche, and disorientation, and which may progress rapidly to hemiparesis, seizures, coma, and death; 5) renal disease which is usually mild, producing only moderate elevations of the serum creatinine and urine protein. Therapeutic plasma exchange is thought to effectively remove these large multimers whereas the infusion of normal plasma may contain proteolytic enzymes that degrade large multimers to a normal size. (From Greco F et Al., "

47. Cancer Care - Medical Update On Myelodysplastic Syndromes (MDS) Medical Update on myelodysplastic syndromes (MDS) 04/10/01 Elihu Estey,MD, University of Texas MD Anderson Cancer Center, discusses http://www.cancercare.org/services/teleconferences/teleconference_17697.asp

48. Myelodysplastic Syndromes myelodysplastic syndromes. The myelodysplastic syndromes are characterizedby maturational defects and ineffective hematopoesis. http://gucfm.georgetown.edu/welchjj/netscut/heme_onc/myelodysplastic.html

Myelodysplastic Syndromes The myelodysplastic syndromes are characterized by maturational defects and ineffective hematopoesis. The marrow appears normal to hypercellular. By definition, the marrow is less than 30% blasts. All three lineages are affected. Symptoms include marrow failure, anemia, pedichiae, bruising. Hepatosplenomegaly is rare. RBCs may appear "megaloblastoid, similar to folate or B12 deficiency. These disorders are more common in adults, usually more than 60 years of age. Often the etiology appears to DNA damage such as exposure to alkylating agents or radiation, or the presence of a DNA repair defect. These disorders may progress to AML. Treatment is supportive with transfusions or stem cell therapy. Typical features of each cell line are: RBCs: ringed sideroblasts (excess iron demonstrated by Prussian blue stain) Megakaryocytes: Pawn ball megakaryocytes, with multiple, separate nuclei. The FAB Classification of myelodysplastic syndromes RA Refractory Anemia RARS Refractory Anemia with Ringed Sideroblasts RAEB Refractory Anemia with Excess Blasts RAEBIT Refractory Anemia with Excess Blasts in Transformation CMML Myeloid Disorders Heme-Onc Net Scut Home Please direct all comments to: Jack Welch, M.D., Ph.D.

49. Myelodysplastic Syndromes Myeloproliferative Disorders. Myeloproliferative disorders involve the proliferationof a somewhat differentiated myeloid line. CML. Adult CML http://gucfm.georgetown.edu/welchjj/netscut/heme_onc/myeloproliferative.html

Myeloproliferative Disorders Myeloproliferative disorders involve the proliferation of a somewhat differentiated myeloid line. CML Adult CML: ACML is a disorder which appears to affect a single progenitor cell which gives rise to all cell lines. Presentation : Patients present with anemia, splenomegaly, constitutional symptoms, abdominal pain, bleeding, and rarely leukestasis. After about 3-6 years, patients enter an accelerated phase which culminates in a blast crisis which is more often myeloid than lymphoid. Laboratories at Diagnosis : WBCs of more than 100,000/uL, platelets of more than 400,000/uL. PMNs, metamyelocytes are present peripherally, with a maximum of about 10% blasts. Bone marrow shows granulocyte hyperplasia, sea blue histiocytes, and sometimes megakaryocyte hyperplasia. The leukocyte alkaline phosphatase and vitamin B12 levels are low. The decreased LAP helps differentiate it from a leukamoid reaction (additionally, in a leukamoid reaction, blasts are not seen in peripheral smears and all cell lines are not elevated). Decreased LAP is also associated with paroxysmal nocturnal hematuria. Genetic : Associated with a t(9;22) which yields a bcr-abl fusion protein of 210 kDa (versus the 185 kDa product in ALL.

50. Myelodysplastic Syndromes -- What Is It? What is it? What are myelodysplastic syndromes? myelodysplastic syndromes occurmost often in older people, but they can occur in younger people. http://www.upmccancercenters.com/cancer/myelo-syndromes/what.cfm

Search Myelodysplastic Syndrome Printer-Friendly Version What is it? What are myelodysplastic syndromes? Myelodysplastic syndromes, also called pre-leukemia or "smoldering" leukemia, are diseases in which the bone marrow does not function normally and not enough normal blood cells are made. The bone marrow is the spongy tissue inside the large bones in the body. The bone marrow makes red blood cells (which carry oxygen and other materials to all tissues of the body), white blood cells (which fight infection), and platelets (which make the blood clot). Normally, bone marrow cells called blasts develop (mature) into several different types of blood cells that have specific jobs in the body. Myelodysplastic syndromes occur most often in older people, but they can occur in younger people. The most common sign is anemia, which means there are too few mature red blood cells to carry oxygen. There may also be too few white blood cells in the blood to fight infections. If the number of platelets in the blood is lower than normal, this may cause people to bleed or bruise more easily. A doctor should be seen if a person bleeds without any reason, bruises more easily than normal, has an infection that won't go away, or feels tired all the time. If there are symptoms, a doctor may order blood tests to count the number of each kind of blood cell. If the results of the blood test are not normal, the doctor may do a bone marrow biopsy. During this test, a needle is inserted into a bone and a small amount of bone marrow is taken out and looked at under the microscope. The doctor can then determine the kind of disease and plan the best treatment.

51. Myelodysplastic Syndromes -- Staging Staging. Stages of myelodysplastic syndromes There is no stagingfor the myelodysplastic syndromes. Treatment depends on whether http://www.upmccancercenters.com/cancer/myelo-syndromes/stage.cfm

Search Myelodysplastic Syndrome Printer-Friendly Version Staging Stages of myelodysplastic syndromes There is no staging for the myelodysplastic syndromes. Treatment depends on whether or not the disease developed following other treatments, or whether the patient has been treated for the myelodysplastic syndrome. Myelodysplastic syndromes are grouped as follows: De novo myelodysplastic syndromes De novo myelodysplastic syndromes develop without any known cause. The patient has not received radiation therapy or chemotherapy for other diseases. Secondary myelodysplastic syndromes Secondary myelodysplastic syndromes develop following treatment with radiation therapy or chemotherapy for other diseases. Previously treated myelodysplastic syndromes Previously treated myelodysplastic syndrome means the disease has been treated but has gotten worse. Further Information: The classification system for staging patients PDQ® information licensed from the National Cancer Institute (NCI). For complete PDQ summaries, visit the NCI at

52. 9 (myelodysplastic Syndromes, MDS) (adult Tcell leukemia/lymphoma,. 9 (myelodysplastic syndromes, MDS). ? http://pathy.med.nagoya-u.ac.jp/leukemia2/node30.html

53. ASH ONLINE myelodysplastic syndromes. By Sonali M. Smith, MD, and Richard A. Larson,MD The myelodysplastic syndromes (MDS) are a heterogeneous http://www.hematology.org/meeting/2002/newsdaily/myelodysplasticsyndromes.cfm

Search Site Map Contact Us Home ... Quality Care Myelodysplastic Syndromes By Sonali M. Smith, M.D., and Richard A. Larson, M.D. The myelodysplastic syndromes (MDS) are a heterogeneous group of disorders characterized by dyspoiesis and propensity for leukemic evolution. New insights into underlying immunologic and molecular defects potentially leading to more targeted treatment strategies are the subject of this year’s myelodysplastic syndromes education session (Saturday, 8:00 a.m., and 2:00 p.m.) Dr. Peter L. Greenberg provides an overview of the clinical approach and treatment options with emphasis on risk stratification using the International Prognostic Scoring System (IPSS). However, newer means of risk stratification in this heterogenous disease challenge the applicability of the IPSS in current clinical decision-making. For example, Hofmann and colleagues (abstract 621) will discuss the use of gene expression profiling to identify genes that discriminate low-risk from high-risk patients during the myelodysplastic syndromes Preclinical Investigations simultaneous session (Monday, 3:15 p.m.-5:15 p.m.), while Benesch and colleagues (abstract 358) will discuss the use of pre-transplantation bone marrow flow cytometric analysis as a prognostic tool for post-transplant clinical outcome at the

54. ASH ONLINE American Society of Hematology. http//www.hematology.org/ Return to ASH Web Site.myelodysplastic syndromes. By Sonali M. Smith, MD, and Richard A. Larson, MD http://www.hematology.org/meeting/2002/newsdaily/myelodysplasticsyndromes.cfm?pa

55. Childhood Myelodysplastic Syndromes And Monosomy 7 Childhood myelodysplastic syndromes and Monosomy 7. Author JuneShen, MD. 02/13/2001. Table of Contents, CLICK HERE TO START. http://www.pathology.med.unc.edu/path/labs/resident_reports/mds_and_monosomy_7/

Childhood Myelodysplastic Syndromes and Monosomy 7 Author: June Shen, MD Table of Contents CLICK HERE TO START Childhood Myelodysplastic Syndromes and Monosomy 7 Myelodysplastic Syndromes (MDS) Chromosomal abnormalities in MDS ... Familial Monosomy 7 Download Microsoft PowerPoint Animation Player for ActiveX Alternatives: If you have problems viewing the PowerPoint Animation, a simple graphic (GIF) version of the presentation is available here . These files are larger than the PowerPoint Animation file, and will take longer to download. A Text Only version of the presentation is also available by clicking here Previous page McLendon Laboratories Home Page Residents Reports Index Please contact with technical problems

56. Childhood Myelodysplastic Syndromes And Monosomy 7 Childhood myelodysplastic syndromes and Monosomy 7. June Shen MD. http://www.pathology.med.unc.edu/path/labs/resident_reports/mds_and_monosomy_7_g

Childhood Myelodysplastic Syndromes and Monosomy 7 June Shen M.D Next slide Back to first slide View graphic version

57. CarePathOnLine™ - Myelodysplastic Syndromes myelodysplastic syndromes, Search, CarePath Code. AA MDISF) (2002). Myelodysplasticsyndromes basic explanations Online. Available http http://www.carepathonline.com/Topic.aspx?Nav=0&Rel=151

58. Myelodysplastic Syndromes myelodysplastic syndromes. myelodysplastic syndromes (MDS) are a group ofhematologic disorders of the pluripotent hematopoietic stem cells. http://www.cancernetwork.com/handbook/Myelodysplastic.htm

Cancer Management: A Multidisciplinary Approach Fifth Edition (2001) Myelodysplastic Syndromes Alvaro Aguayo, MD, Jorge E. Cortes, MD, and Hagop Kantarjian, MD Epidemiology Etiology and risk factors Classification Signs and symptoms ... Suggested reading M yelodysplastic syndromes (MDS) are a group of hematologic disorders of the pluripotent hematopoietic stem cells. These disorders are characterized by ineffective hematopoiesis, including abnormalities in proliferation, differentiation, and apoptosis. The overall clinical result is peripheral cytopenias in the setting of a normocellular or hypercellular bone marrow and a high incidence of transformation to acute leukemia. Epidemiology Gender The overall incidence of MDS is slightly higher in males than in females (1.5-2:1). In the older age groups (over 55), men are affected with MDS approximately twice as often as women. There is no sex difference in the incidence of MDS in children and young adults. Age MDS is a disease associated with age, with a median age at diagnosis of about 70 years. MDS is rare in children; childhood cases are usually associated with monosomy of chromosome 7. Etiology and risk factors MDS is a clonal disorder of bone marrow stem cells. The vast majority of cases (80%-90%) occur "de novo," while 10%-20% of cases are secondary. The etiology of de novo MDS is unclear. Exposure to radiation and/or cytotoxic agents and a history of a clonal disorder are recognized etiologic factors.

59. Cytogenic And Clonal Profile Of Myelodysplastic Syndromes (MDS) Patients Treated Cytogenetic and Clonal Profile of myelodysplastic syndromes (MDS) PatientsTreated with Thalidomide. S. Alvi, M. Shaikh, S. Anthwal http://www.unc.edu/~novick/abstract.html

Cytogenetic and Clonal Profile of Myelodysplastic Syndromes (MDS) Patients Treated with Thalidomide. S. Alvi, M. Shaikh, S. Anthwal, A. Shaher, D. Tamoseviciene, A. Novick, P. Reddy, K. Allampallam, W. T. Hsu, N. Galili, R. Z. Borok, A. Raza. MDS Center, Rush Presbyterian St. Luke's Medical Center, Chicago, IL

60. About Myelodysplastic Syndromes myelodysplastic syndromes. myelodysplastic syndromes (MDS) are a group ofdiseases that originate in an early bloodforming cell in the marrow. http://www.jimmylange.com/leukemia/aboutMyelodysplasticSyndromes.htm

About the Diseases Leukemia Lymphoma Hodgkin's Lymphoma Myeloma ... Main Page Myelodysplastic Syndromes Myelodysplastic syndromes (MDS) are a group of diseases that originate in an early blood-forming cell in the marrow. In patients with this disorder, the marrow produces too few red blood cells, white blood cells and often platelets. In MDS, the maturing blood cells often die in the marrow before they reach full maturity and enter the blood, accounting for the low blood cell concentrations. There may also be an accumulation of very immature marrow cells, called leukemic blast cells. The severity of the marrow cell disturbance is varied and can range from mild to very severe. Thus, the disease may be indolent or chronic and may manifest primarily as mild anemia; it may have severe decreases in red and white blood cells and platelets and be more troublesome; or, it may have severe decreases in blood cells and have leukemic blast cells in the marrow and be even more threatening to the health of the patient. In addition, the disease can progress such that the leukemic blast cells take over the marrow and the disease evolves into acute myelogenous leukemia. The marked decrease in blood cell formation makes it difficult for patients to prevent or fight infection, and it predisposes them to exaggerated bleeding. Incidence

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