MDS的诊治进展.pptVIP

Minimal diagnostic criteria in MDSa (A) Prerequisite criteria Constant cytopenia in one or more of the following cell lineages: erythroid (hemoglobin 11 g dL?1); neutrophilic (ANC 1500L?1) or megakaryocytic (platelets 100,000L?1) Exclusion of all other hematopoietic or non-hematopoietic disorders as primary reason for cytopenia/dysplasiab (B) MDS-related (decisive) criteria Dysplasia in at least 10% of all cells in one of the following lineages in the bone marrow smear: erythroid; neutrophilic; or megakaryocytic or 15% ringed sideroblasts (iron stain) 5–19% Blast cells in bone marrow smears Typical chromosomal abnormality (by conventional karyotyping or FISH (C) Co-criteriad (for patients fulfilling ‘A’ but not ‘B’, and otherwise show typical clinical features, e.g. macrocytic transfusion-dependent anemia) Abnormal phenotype of bone marrow cells clearly indicative of a monoclonal population of erythroid or/and myeloid cells, determined by flow cytometry Clear molecular signs of a monoclonal cell population in HUMARA assay, gene chip profiling, or point mutation analysis (e.g. RAS mutations) Markedly and persistently reduced colony-formation (±cluster formation) of bone marrow or/and circulating progenitor cells (CFU-assay) The diagnosis MDS can be established when both prerequisite criteria and at least one decisive criterion are fulfilled. If no decisive criterion is fulfilled, but the patient is likely to suffer from a clonal myeloid disease, co-criteria should be applied and may help in reaching the conclusion the patient has MDS or a condition called ‘highly suspective of MDS’. Typical chromosome abnormalities are those that are recurrently found in MDS (+8, ?7, 5q?, 20q?, others). If the abnormal karyotype is the only decisive criterion, the condition should be considered as ‘highly suspective of MDS’. Co-criteria are not considered to be used as standard in the routine hematologic work up in all centers. If not a