Mandel et al proposed a classification for pediatric myelodysplasia. This is a practical classification that correlates with outcome. The authors are from the Hospital for Sick Children and the University of Toronto in Canada.
Parameters:
(1) category
(2) cytology (refractory cytopenias with percent blasts)
(3) cytogenetics
Categories:
(1) related to an inherited syndrome
(2) related to toxin or treatment
(3) idiopathic (de novo, none of the above)
Refractory Cytopenia (RC)
Blasts < 5%
Blast Excess (BE) at 5 - 30%
without dysplasia
RC
RCEB
with dysplasia
RCD
RCDEB
with ringed sideroblasts
RCRS
RCRSEB
where:
• The refractory cytopenia may involve one or more lineages.
• A blast count > 30% indicates acute leukemia.
Cytogenetics:
(1) unknown (CG0)
(2) normal (CG-)
(3) abnormal (CG+)
The more abnormal the designations the worse the outcome.
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