Summary
Definition
History and exam
Key diagnostic factors
- edad avanzada
- fatiga
- intolerancia al ejercicio
- palidez
- hematomas o sangrado
- quimioterapia y/o radioterapia previa
- trastorno congénito
- infecciones bacterianas
Other diagnostic factors
- presencia de factores de riesgo
- trastornos autoinmunitarios
- esplenomegalia
- hepatomegalia
- linfadenopatía
Risk factors
- edad >70 años
- quimioterapia previa
- radioterapia previa
- Trasplante autólogo previo de células madre hematopoyéticas
- trastornos congénitos
- tabaco
- benceno
- anemia aplásica
- hemoglobinuria paroxística nocturna (HPN)
Diagnostic tests
1st tests to order
- hemograma completo (HC) con diferencial
- frotis de sangre periférica
- recuento de reticulocitos
- folato en hematíes
- vitamina B12 sérica
- análisis de hierro
- aspiración de médula ósea con tinción de hierro
- biopsia de médula ósea con aguja gruesa
- pruebas genéticas
Tests to consider
- serología viral
- eritropoyetina sérica
- lactato deshidrogenasa
- tipificación del antígeno leucocitario humano (ALH)
- citometría de flujo
Treatment algorithm
enfermedad de menor riesgo: asintomática
enfermedad de menor riesgo: MDS-5q (del(5q) ± otra alteración citogenética, excepto las que afectan al cromosoma 7) con anemia sintomática
enfermedad de menor riesgo: SMD-SF3B1 (sin del(5q) ± otras alteraciones citogenéticas con sideroblastos en anillo ≥15% [o ≥5% con una mutación en SF3B1]) con anemia sintomática
enfermedad de menor riesgo: sin del(5q) con sideroblastos en anillo <15% (o <5% con una mutación en SF3B1) con anemia sintomática
enfermedad de menor riesgo: con trombocitopenia o neutropenia clínicamente relevante (sin anemia sintomática)
enfermedad de alto riesgo: candidato a trasplante
enfermedad de alto riesgo: no candidato a trasplante
Contributors
Authors
Vijaya Raj Bhatt, MBBS, MS
Associate Professor
Section Leader, Malignant Hematology
University of Nebraska Medical Center Division of Hematology-Oncology
Nebraska
NE
Disclosures
VRB has participated in a Safety Monitoring Committee for Protagonist Therapeutics and served as an Associate Editor for the journal Current Problems in Cancer. He has received consulting fees from Taiho, Sanofi, Imugene, Genentech, Incyte, Servier Pharmaceuticals, and AbbVie; research funding (institutional) from MEI Pharma, Actinium Pharmaceutical, Sanofi, AbbVie, Pfizer, Incyte, Jazz, and NMDP; and drug support (institutional) from Chimerix for a trial.
Prajwal Dhakal, MBBS
Clinical Assistant Professor of Internal Medicine-Hematology, Oncology, and Blood and Marrow Transplantation
University of Iowa
Iowa City
IA
Disclosures
PPD has been reimbursed by the Aplastic Anemia and MDS International Foundation for presenting on the topic 'High-risk MDS: non-transplant therapies, current therapies, and clinical trials' in a patient and family conference. PD has received consulting fees from AbbVie pharmaceuticals.
Acknowledgements
Dr Vijaya Raj Bhatt and Dr Prajwal Dhakal would like to gratefully acknowledge Professor Apar Kishor Ganti and Associate Professor Alissa Marr, previous contributors to this topic.
Disclosures
AKG has received research support from Amgen, Apexigen, Bristol-Myers Squibb, Janssen, Merck, New Link Genetics, Pfizer, and Takeda Oncology. AKG has been reimbursed for consulting work for AbbVie and Genentech. None of the grants or payments relate to work involving myelodysplastic syndrome. AM declares that she has no competing interests.
Peer reviewers
David P. Steensma, MD, FACP
Associate Professor of Medicine (Hematology) and Oncology
Division of Hematology
Department of Medicine
Mayo Clinic
Rochester
MN
Disclosures
DPS declares that he has no competing interests.
Adrian C. Newland, BA, MB, BCh, MA, FRCP, FRCPath
Professor of Haematology
Queen Mary University
London
UK
Disclosures
ACN declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Killick SB, Wiseman DH, Quek L, et al. British Society for Haematology guidelines for the diagnosis and evaluation of prognosis of adult myelodysplastic syndromes. Br J Haematol. 2021 Jul;194(2):282-93.Full text Abstract
Killick SB, Ingram W, Culligan D, et al. British Society for Haematology guidelines for the management of adult myelodysplastic syndromes. Br J Haematol. 2021 Jul;194(2):267-81.Full text Abstract
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: myelodysplastic syndromes [internet publication].Full text
Fenaux P, Haase D, Santini V, et al; ESMO Guidelines Committee. Myelodysplastic syndromes: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021 Feb;32(2):142-56.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Anemia aplásica
- Infección por VIH
- Otras infecciones virales (p. ej., parvovirus, CMV o hepatitis)
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: myelodysplastic syndromes
- British Society for Haematology guidelines for the management of adult myelodysplastic syndromes
More Guidelines
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