Published online 6 October 2008
Haematologica, Vol 93, Issue 11, 1712-1717 doi:10.3324/haematol.13405
Copyright © 2008 by Ferrata Storti Foundation

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Decision Making and Problem Solving

Diagnosis and classification of myelodysplastic syndrome: International Working Group on Morphology of myelodysplastic syndrome (IWGM-MDS) consensus proposals for the definition and enumeration of myeloblasts and ring sideroblasts

Ghulam J. Mufti¹, John M. Bennett², Jean Goasguen³, Barbara J. Bain⁴, Irith Baumann⁵, Richard Brunning⁶, Mario Cazzola⁷, Pierre Fenaux⁸, Ulrich Germing⁹, Eva Hellström-Lindberg¹⁰, Itsuro Jinnai¹¹, Atsushi Manabe¹², Akira Matsuda¹³, Charlotte M. Niemeyer¹⁴, Guillermo Sanz¹⁵, Masao Tomonaga¹⁶, Teresa Vallespi¹⁷, Ayami Yoshimi¹⁸

¹ King’s College, London, United Kingdom
² James P. Wilmot Cancer Center, Rochester, New York, USA
³ Université de Rennes, Rennes, France
⁴ St. Mary’s Hospital Campus of Imperial College, London, United Kingdom
⁵ Institute of Pathology, Medical Hospital, Bayreuth, Germany
⁶ University of Minnesota, Minneapolis, Minnesota, USA
⁷ University of Pavia and Fondazione IRCCS Policlinico San Matteo, Italy
⁸ Université Paris XIII, Bobigny, France
⁹ University Dusseldorf, Dusseldorf, Germany
¹⁰ Karolinska Institute, Stockholm, Sweden
¹¹ Saitama Medical University, Saitama, Japan
¹² St Luke’s International Hospital, Chuo-ku, Japan
¹³ Saitama Medical University, Saitama, Japan
¹⁴ University of Freiburg, Freiburg, Germany
¹⁵ Hospital Universitario La Fe, Valencia, Spain
¹⁶ Nagasaki University School of Medicine, Nagasaki, Japan
¹⁷ Hospital Universitario Vall d’Hebron, Barcelona, Spain and
¹⁸ University of Freiburg, Freiburg, Germany

Correspondence: Ghulam Mufti, Department of Haematology, King’s College Hospital, Denmark Hill, London, SE5 9RS United Kingdom. E.mail:ghulam.mufti{at}kcl.ac.uk

ABSTRACT

The classification of myelodysplastic syndromes is based on the morphological criteria proposed by the French-American-British (FAB) and World Health Organization (WHO) groups. Accurate enumeration of blast cells, although essential for diagnosis of myelodysplastic syndrome and for assignment to prognostic groups, is often difficult, due to imprecise criteria for the morphological definition of blasts and promyelocytes. An International Working Group on Morphology of Myelodysplastic Syndrome (IWGM-MDS) of hematopathologists and hematologists expert in the field of myelodysplastic syndrome reviewed the morphological features of bone marrows from all subtypes of myelodysplastic syndrome and agreed on a set of recommendations, including recommendations for the definition and enumeration of blast cells and ring sideroblasts. It is recommended that (1) agranular or granular blast cells be defined (replacing the previous type I, II and III blasts), (2) dysplastic promyelocytes be distinguished from cytologically normal promyelocytes and from granular blast cells, (3) sufficient cells be counted to give a precise blast percentage, particularly at thresholds that are important for diagnosis or prognosis and (4) ring sideroblasts be defined as erythroblasts in which there are a minimum of 5 siderotic granules covering at least a third of the nuclear circumference. Clear definitions and a differential count of a sufficient number of cells is likely to improve precision in the diagnosis and classification of myelodysplastic syndrome. Recommendations should be applied in the context of the WHO classification.

Key words: myelodysplastic syndrome, myelodysplastic syndrome, myeloblast, ring sideroblast.

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