Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Myelodysplasia Medication

  • Author: Natalia Dixon, MD; Chief Editor: Robert J Arceci, MD, PhD  more...
 
Updated: Oct 01, 2013
 

Medication Summary

Several aspects of the management of pediatric myelodysplasia syndrome (MDS) differ from adult myelodysplasia therapy. Most importantly, the treatment goal must be curative because prolonging life by 5-8 years is not considered successful therapy in a healthy 10-year-old patient as it might in a 90-year-old patient who has other health problems. Therefore, allogeneic HSCT should almost always be the goal for children with myelodysplasia syndrome. However, the timing of HSCT is variable in children depending on symptomatology, disease characteristics, donor availability, and weighing the risks and benefits of transplant with the child’s quality of life.

The relevance of immunomodulating agents in pediatrics is investigational and remains unclear.

Various agents have been used to slow the progression of myelodysplasia syndrome, including low-dose cytosine arabinoside, cladribine (2-CdA), growth factors (erythropoietin, granulocyte colony-stimulating factor [G-CSF]), amifostine, and hydroxyurea. These agents are temporizing at best, and their role has been limited to palliation of myelodysplasia syndrome while a donor search takes place. In adults, decitabine, azacitidine, and lenalidomide (used primarily for 5q-syndrome) can reduce the need for transfusion and, in some cases, delay progression to AML when used in the correct subsets of patients.

Patients who present with a high percentage of marrow blasts and rapidly progressive disease may require chemotherapy while preparing for transplant. Both de novo and therapy-related myelodysplasia syndrome are usually only transiently responsive to conventional chemotherapy, which can be used in an attempt to keep the patient in remission until allogeneic HSCT can be performed. Transplantation from an HLA-matched family donor is optimal, but alternative donors should be considered when an HLA-matched family donor is not available.[33, 34]

Therapy prior to transplant also involves the judicious use of blood products and aggressive infection control because patients are often agranulocytic.

Next

DNA hypomethylating agents

Class Summary

These agents are indicated for myelodysplastic syndrome in adults.

Azacitidine (Vidaza)

 

Pyrimidine nucleoside analog of cytidine. Interferes with nucleic acid metabolism. Exerts antineoplastic effects by DNA hypomethylation and direct cytotoxicity on abnormal hematopoietic bone marrow cells. Hypomethylation may restore normal function to genes critical for cell differentiation and proliferation. Nonproliferative cells are largely insensitive to azacitidine. Indicated to treat MDS. FDA approved for all 5 MDS subtypes.

Decitabine (Dacogen)

 

Hypomethylating agent believed to exert antineoplastic effects by incorporating into DNA and inhibiting methyltransferase, resulting in hypomethylation. Hypomethylation in neoplastic cells may restore normal function to genes critical for cellular control of differentiation and proliferation. Indicated for treatment of MDS, including previously treated and untreated, de novo, and secondary MDS of all FAB subtypes (ie, RA, RARS, RAEB, RAEBT, CML) and IPSS groups intermediate-1 risk, intermediate-2 risk, and high risk.

Previous
Next

Immunomodulating agents

Class Summary

These agents are indicated for myelodysplasia syndrome in adults.

Lenalidomide (Revlimid)

 

Indicated for transfusion-dependent MDS subtype of deletion 5q31 cytogenetic abnormality. Structurally similar to thalidomide. Elicits immunomodulatory and antiangiogenic properties. Inhibits proinflammatory cytokine secretion and increases anti-inflammatory cytokines from peripheral blood mononuclear cells. The drug is FDA approved for adult patients with low or intermediate-1 IPSS category who are unlikely to respond to erythropoietin

Previous
 
 
Contributor Information and Disclosures
Author

Natalia Dixon, MD Assistant Professor, Department of Pediatrics, Division of Hematology and Oncology, Wake Forest University School of Medicine

Natalia Dixon, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Children's Oncology Group

Disclosure: Nothing to disclose.

Coauthor(s)

Sharon M Castellino, MD, MSc, FAAP Associate Professor, Department of Pediatrics, Section Pediatric Hematology-Oncology, Wake Forest University Health Sciences

Sharon M Castellino, MD, MSc, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society of Hematology, American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Scott C Howard, MD Founder and CEO, Resonance, LLC; Consultant in Oncology, Healthcare Informatics, Global Health, Research; Adjunct Professor, University of Memphis School of Health Studies

Scott C Howard, MD is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Central American Pediatric Hematology-Oncology Association, Columbian Pediatric Hematology/Oncology Society, International Society of Paediatric Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

James L Harper, MD Associate Professor, Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplantation, Associate Chairman for Education, Department of Pediatrics, University of Nebraska Medical Center; Associate Clinical Professor, Department of Pediatrics, Creighton University School of Medicine; Director, Continuing Medical Education, Children's Memorial Hospital; Pediatric Director, Nebraska Regional Hemophilia Treatment Center

James L Harper, MD is a member of the following medical societies: American Society of Pediatric Hematology/Oncology, American Federation for Clinical Research, Council on Medical Student Education in Pediatrics, Hemophilia and Thrombosis Research Society, American Academy of Pediatrics, American Association for Cancer Research, American Society of Hematology

Disclosure: Nothing to disclose.

Chief Editor

Robert J Arceci, MD, PhD Director, Children’s Center for Cancer and Blood Disorders, Department of Hematology/Oncology, Co-Director of the Ron Matricaria Institute of Molecular Medicine, Phoenix Children’s Hospital; Editor-in-Chief, Pediatric Blood and Cancer; Professor, Department of Child Health, University of Arizona College of Medicine

Robert J Arceci, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American Association for Cancer Research, American Pediatric Society, American Society of Hematology, American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Additional Contributors

Sharada A Sarnaik, MBBS Professor of Pediatrics, Wayne State University School of Medicine; Director, Sickle Cell Center, Associate Hematologist/Oncologist, Children's Hospital of Michigan

Sharada A Sarnaik, MBBS is a member of the following medical societies: American Society of Hematology, American Society of Pediatric Hematology/Oncology, New York Academy of Sciences, Society for Pediatric Research, Children's Oncology Group, American Academy of Pediatrics, Midwest Society for Pediatric Research

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Carmen Arkansas, MD, and Glenda Grawe, MD, to the development and writing of this article.

References
  1. Barlogie B, Johnston DA, Keating M, et al. Evolution of oligoleukemia. Cancer. 1984 May 15. 53(10):2115-24. [Medline].

  2. Jaffe ES, Harris NL, Stein H, et al, eds. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. 3rd ed. International Agency for Research on Cancer (IARC); 2001.

  3. Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR, et al. Proposals for the classification of the myelodysplastic syndromes. Br J Haematol. 1982 Jun. 51(2):189-99. [Medline].

  4. Swerdlow SH, Campo E, Harris NL, et al, eds. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. 4th ed. Lyon, France: International Agency for Research on Cancer (IARC); 2008.

  5. Tefferi A, Vardiman JW. Myelodysplastic syndromes. N Engl J Med. 2009 Nov 5. 361(19):1872-85. [Medline].

  6. Owen C, Barnett M, Fitzgibbon J. Familial myelodysplasia and acute myeloid leukaemia--a review. Br J Haematol. 2008 Jan. 140(2):123-32. [Medline].

  7. Kalra R, Paderanga DC, Olson K, Shannon KM. Genetic analysis is consistent with the hypothesis that NF1 limits myeloid cell growth through p21ras. Blood. 1994 Nov 15. 84(10):3435-9. [Medline].

  8. Shannon KM, O'Connell P, Martin GA, Paderanga D, Olson K, Dinndorf P, et al. Loss of the normal NF1 allele from the bone marrow of children with type 1 neurofibromatosis and malignant myeloid disorders. N Engl J Med. 1994 Mar 3. 330(9):597-601. [Medline].

  9. Ortmann CA, Niemeyer CM, Wawer A, Ebell W, Baumann I, Kratz CP. TERC mutations in children with refractory cytopenia. Haematologica. 2006 May. 91(5):707-8. [Medline].

  10. Marrone A, Sokhal P, Walne A, Beswick R, Kirwan M, Killick S, et al. Functional characterization of novel telomerase RNA (TERC) mutations in patients with diverse clinical and pathological presentations. Haematologica. 2007 Aug. 92(8):1013-20. [Medline].

  11. Vidal DO, Paixao VA, Brait M, et al. Aberrant methylation in pediatric myelodysplastic syndrome. Leuk Res. 2007 Feb. 31(2):175-81. [Medline].

  12. Hasle H, Kerndrup G, Jacobsen BB. Childhood myelodysplastic syndrome in Denmark: incidence and predisposing conditions. Leukemia. 1995 Sep. 9(9):1569-72. [Medline].

  13. Emanuel PD. Myelodysplasia and myeloproliferative disorders in childhood: an update. Br J Haematol. 1999 Jun. 105(4):852-63. [Medline].

  14. Hasle H, Jacobsen BB, Pedersen NT. Myelodysplastic syndromes in childhood: a population based study of nine cases. Br J Haematol. 1992 Aug. 81(4):495-8. [Medline].

  15. Passmore SJ, Chessells JM, Kempski H, Hann IM, Brownbill PA, Stiller CA. Paediatric myelodysplastic syndromes and juvenile myelomonocytic leukaemia in the UK: a population-based study of incidence and survival. Br J Haematol. 2003 Jun. 121(5):758-67. [Medline].

  16. Pui CH, Schrappe M, Ribeiro RC, Niemeyer CM. Childhood and adolescent lymphoid and myeloid leukemia. Hematology Am Soc Hematol Educ Program. 2004. 118-45. [Medline].

  17. Aul C, Gattermann N, Schneider W. Age-related incidence and other epidemiological aspects of myelodysplastic syndromes. Br J Haematol. 1992 Oct. 82(2):358-67. [Medline].

  18. Arico M, Biondi A, Pui CH. Juvenile myelomonocytic leukemia. Blood. 1997 Jul 15. 90(2):479-88. [Medline].

  19. Kardos G, Baumann I, Passmore SJ, Locatelli F, Hasle H, Schultz KR. Refractory anemia in childhood: a retrospective analysis of 67 patients with particular reference to monosomy 7. Blood. 2003 Sep 15. 102(6):1997-2003. [Medline].

  20. Bhatia S, Krailo MD, Chen Z, Burden L, Askin FB, Dickman PS, et al. Therapy-related myelodysplasia and acute myeloid leukemia after Ewing sarcoma and primitive neuroectodermal tumor of bone: A report from the Children's Oncology Group. Blood. 2007. 109(1):46-51.

  21. Hasle H. Myelodysplastic and myeloproliferative disorders in children. Curr Opin Pediatr. 2007 Feb. 19(1):1-8. [Medline].

  22. Barnard DR, Woods WG. Treatment-related myelodysplastic syndrome/acute myeloid leukemia in survivors of childhood cancer--an update. Leuk Lymphoma. 2005 May. 46(5):651-63. [Medline].

  23. Teo JT, Klaassen R, Fernandez CV, Yanofsky R, Wu J, Champagne J. Clinical and genetic analysis of unclassifiable inherited bone marrow failure syndromes. Pediatrics. 2008 Jul. 122(1):e139-48. [Medline].

  24. Auletta JJ, Shurin S. Improved hematopoiesis using amifostine in secondary myelodysplasia. J Pediatr Hematol Oncol. 1999 Nov-Dec. 21(6):531-4. [Medline].

  25. Bader-Meunier B, Mielot F, Tchernia G, et al. Myelodysplastic syndromes in childhood: report of 49 patients from a French multicentre study. French Society of Paediatric Haematology and Immunology. Br J Haematol. 1996 Feb. 92(2):344-50. [Medline].

  26. Mandel K, Dror Y, Poon A, Freedman MH. A practical, comprehensive classification for pediatric myelodysplastic syndromes: the CCC system. J Pediatr Hematol Oncol. 2002 Oct. 24(7):596-605. [Medline].

  27. Hasle H, Niemeyer CM, Chessells JM, Baumann I, Bennett JM, Kerndrup G. A pediatric approach to the WHO classification of myelodysplastic and myeloproliferative diseases. Leukemia. 2003 Feb. 17(2):277-82. [Medline].

  28. Occhipinti E, Correa H, Yu L, Craver R. Comparison of two new classifications for pediatric myelodysplastic and myeloproliferative disorders. Pediatr Blood Cancer. 2005 Mar. 44(3):240-4. [Medline].

  29. Vardiman JW, Thiele J, Arber DA, Brunning RD, Borowitz MJ, Porwit A. The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood. 2009 Jul 30. 114(5):937-51. [Medline].

  30. Vardiman JW. Hematopathological concepts and controversies in the diagnosis and classification of myelodysplastic syndromes. Hematology Am Soc Hematol Educ Program. 2006. 199-204. [Medline].

  31. Gupta V, Brooker C, Tooze JA, Yi QL, Sage D, Turner D. Clinical relevance of cytogenetic abnormalities at diagnosis of acquired aplastic anaemia in adults. Br J Haematol. 2006 Jul. 134(1):95-9. [Medline].

  32. Bierings M, Nachman JB, Zwaan CM. Stem cell transplantation in pediatric leukemia and myelodysplasia: state of the art and current challenges. Curr Stem Cell Res Ther. 2007 Jan. 2(1):53-63. [Medline].

  33. Bunin N, Saunders F, Leahey A, et al. Alternative donor bone marrow transplantation for children with juvenile myelomonocytic leukemia. J Pediatr Hematol Oncol. 1999 Nov-Dec. 21(6):479-85. [Medline].

  34. Kalwak K, Wojcik D, Gorczynska E, et al. Allogeneic hematopoietic cell transplantation from alternative donors in children with myelodysplastic syndrome: is that an alternative?. Transplant Proc. 2004 Jun. 36(5):1574-7. [Medline].

  35. Mantadakis E, Shannon KM, Singer DA, Finklestein J, Chan KW, Hilden JM. Transient monosomy 7: a case series in children and review of the literature. Cancer. 1999 Jun 15. 85(12):2655-61. [Medline].

  36. Barnard DR, Alonzo TA, Gerbing RB, Lange B, Woods WG. Comparison of childhood myelodysplastic syndrome, AML FAB M6 or M7, CCG 2891: report from the Children's Oncology Group. Pediatr Blood Cancer. 2007 Jul. 49(1):17-22. [Medline].

  37. Bennett JM. Classification of the myelodysplastic syndromes. Clin Haematol. 1986 Nov. 15(4):909-23. [Medline].

  38. Boogaerts MA, Nelissen V, Roelant C, Goossens W. Blood neutrophil function in primary myelodysplastic syndromes. Br J Haematol. 1983 Oct. 55(2):217-27. [Medline].

  39. Cheson BD, Greenberg PL, Bennett JM, et al. Clinical application and proposal for modification of the International Working Group (IWG) response criteria in myelodysplasia. Blood. 2006 Jul 15. 108(2):419-25. [Medline].

  40. Clark R, Peters S, Hoy T, et al. Prognostic importance of hypodiploid hemopoietic precursors in myelodysplastic syndromes. N Engl J Med. 1986 Jun 5. 314(23):1472-5. [Medline].

  41. De Witte T, Van Biezen A, Hermans J, et al. Autologous bone marrow transplantation for patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia following MDS. Chronic and Acute Leukemia Working Parties of the European Group for Blood and Marrow Transplantation. Blood. 1997 Nov 15. 90(10):3853-7. [Medline]. [Full Text].

  42. Dewald GW, Pierre RV, Phyliky RL. Three patients with structurally abnormal X chromosomes, each with Xq13 breakpoints and a history of idiopathic acquired sideroblastic anemia. Blood. 1982 Jan. 59(1):100-5. [Medline].

  43. Fohlmeister I, Fischer R, Mödder B, Rister M, Schaefer HE. Aplastic anaemia and the hypocellular myelodysplastic syndrome: histomorphological, diagnostic, and prognostic features. J Clin Pathol. 1985 Nov. 38(11):1218-24. [Medline]. [Full Text].

  44. Freedman MH, Bonilla MA, Fier C, et al. Myelodysplasia syndrome and acute myeloid leukemia in patients with congenital neutropenia receiving G-CSF therapy. Blood. 2000 Jul 15. 96(2):429-36. [Medline]. [Full Text].

  45. Golde DW. The stem cell. Sci Am. 1991 Dec. 265(6):86-93. [Medline].

  46. Hasegawa D, Manabe A, Kubota T, et al. Methylation status of the p15 and p16 genes in paediatric myelodysplastic syndrome and juvenile myelomonocytic leukaemia. Br J Haematol. 2005 Mar. 128(6):805-12. [Medline].

  47. Hasle H, Arico M, Basso G, et al. Myelodysplastic syndrome, juvenile myelomonocytic leukemia, and acute myeloid leukemia associated with complete or partial monosomy 7. European Working Group on MDS in Childhood (EWOG-MDS). Leukemia. 1999 Mar. 13(3):376-85. [Medline].

  48. Hasle H, Baumann I, Bergstrasser E, et al. The International Prognostic Scoring System (IPSS) for childhood myelodysplastic syndrome (MDS) and juvenile myelomonocytic leukemia (JMML). Leukemia. 2004 Dec. 18(12):2008-14. [Medline].

  49. Heaney ML, Golde DW. Myelodysplasia. N Engl J Med. 1999 May 27. 340(21):1649-60. [Medline].

  50. Hofmann WK, Ottmann OG, Ganser A, Hoelzer D. Myelodysplastic syndromes: clinical features. Semin Hematol. 1996 Jul. 33(3):177-85. [Medline].

  51. Ingram W, Lim ZY, Mufti GJ. Allogeneic transplantation for myelodysplastic syndrome (MDS). Blood Rev. 2006 Jun 5. [Medline].

  52. Jackson GH, Carey PJ, Cant AJ, et al. Myelodysplastic syndromes in children [letter]. Br J Haematol. 1993 May. 84(1):185-6. [Medline].

  53. Jacobs RH, Cornbleet MA, Vardiman JW, et al. Prognostic implications of morphology and karyotype in primary myelodysplastic syndromes. Blood. 1986 Jun. 67(6):1765-72. [Medline].

  54. Juneja SK, Imbert M, Jouault H, Scoazec JY, Sigaux F, Sultan C. Haematological features of primary myelodysplastic syndromes (PMDS) at initial presentation: a study of 118 cases. J Clin Pathol. 1983 Oct. 36(10):1129-35. [Medline]. [Full Text].

  55. Kahn A. Abnormalities of erythrocyte enzymes in dyserythropoiesis and malignancies. Clin Haematol. 1981 Feb. 10(1):123-38. [Medline].

  56. Koeffler HP, Golde DW. Human preleukemia. Ann Intern Med. 1980 Aug. 93(2):347-53. [Medline].

  57. Larson RA. Myelodysplasia: when to treat and how. Best Pract Res Clin Haematol. 2006. 19(2):293-300. [Medline].

  58. Loh ML, Sakai DS, Flotho C, Kang M, Fliegauf M, Archambeault S. Mutations in CBL occur frequently in juvenile myelomonocytic leukemia. Blood. 2009 Aug 27. 114(9):1859-63. [Medline]. [Full Text].

  59. Luna-Fineman S, Shannon KM, Atwater SK, et al. Myelodysplastic and myeloproliferative disorders of childhood: a study of 167 patients. Blood. 1999 Jan 15. 93(2):459-66. [Medline]. [Full Text].

  60. Luna-Fineman S, Shannon KM, Lange BJ. Childhood monosomy 7: epidemiology, biology, and mechanistic implications. Blood. 1995 Apr 15. 85(8):1985-99. [Medline]. [Full Text].

  61. Maldonado JE, Maigne J, Lecoq D. Comparative electron-microscopic study of the erythrocytic line in refractory anemia (preleukemia) and myelomonocytic leukemia. Nouv Rev Fr Hematol Blood Cells. 1976. 17(1-2):167-85. [Medline].

  62. Martin S, Baldock SC, Ghoneim AT, Child JA. Defective neutrophil function and microbicidal mechanisms in the myelodysplastic disorders. J Clin Pathol. 1983 Oct. 36(10):1120-8. [Medline]. [Full Text].

  63. McKenna RW. Myelodysplasia and myeloproliferative disorders in children. Am J Clin Pathol. 2004 Dec. 122 Suppl:S58-69. [Medline].

  64. Mecucci C, Tricot G, Boogaerts M, Van den Berghe H. An identical translocation between chromosome 1 and 15 in two patients with myelodysplastic syndromes [published erratum appears in Br J Haematol 1987 Apr;65(4):508]. Br J Haematol. 1986 Mar. 62(3):439-45. [Medline].

  65. Moir DJ, Jones PA, Pearson J, et al. A new translocation, t(1;3) (p36;q21), in myelodysplastic disorders. Blood. 1984 Aug. 64(2):553-5. [Medline].

  66. Nand S, Godwin JE. Hypoplastic myelodysplastic syndrome. Cancer. 1988 Sep 1. 62(5):958-64. [Medline].

  67. Negendank W, Weissman D, Bey TM, et al. Evidence for clonal disease by magnetic resonance imaging in patients with hypoplastic marrow disorders. Blood. 1991 Dec 1. 78(11):2872-9. [Medline]. [Full Text].

  68. Newman DR, Pierre RV, Linman JW. Studies on the diagnostic significance of hemoglobin F levels. Mayo Clin Proc. 1973 Mar. 48(3):199-202. [Medline].

  69. Niemeyer CM, Baumann I. Myelodysplastic syndrome in children and adolescents. Semin Hematol. 2008 Jan. 45(1):60-70. [Medline].

  70. O'Donnell MR, Nademanee AP, Snyder DS, et al. Bone marrow transplantation for myelodysplastic and myeloproliferative syndromes. J Clin Oncol. 1987 Nov. 5(11):1822-6. [Medline].

  71. Ogawa M. Differentiation and proliferation of hematopoietic stem cells. Blood. 1993 Jun 1. 81(11):2844-53. [Medline].

  72. Passmore SJ, Hann IM, Stiller CA, et al. Pediatric myelodysplasia: a study of 68 children and a new prognostic scoring system. Blood. 1995 Apr 1. 85(7):1742-50. [Medline]. [Full Text].

  73. Raskind WH, Tirumali N, Jacobson R, et al. Evidence for a multistep pathogenesis of a myelodysplastic syndrome. Blood. 1984 Jun. 63(6):1318-23. [Medline].

  74. Rosenthal DS, Moloney WC. Refractory dysmyelopoietic anemia and acute leukemia. Blood. 1984 Feb. 63(2):314-8. [Medline].

  75. Russell NH, Keenan JP, Bellingham AJ. Thrombocytopathy in preleukaemia: association with a defect of thromboxane A2 activity. Br J Haematol. 1979 Mar. 41(3):417-25. [Medline].

  76. Ruter B, Wijermans PW, Lubbert M. Superiority of prolonged low-dose azanucleoside administration? Results of 5-aza-2'-deoxycytidine retreatment in high-risk myelodysplasia patients. Cancer. 2006 Apr 15. 106(8):1744-50. [Medline].

  77. Sasaki H, Manabe A, Kojima S, et al. Myelodysplastic syndrome in childhood: a retrospective study of 189 patients in Japan. Leukemia. 2001 Nov. 15(11):1713-20. [Medline].

  78. Scheres JM, Hustinx TW, Holdrinet RS, et al. Translocation 1;7 in dyshematopoiesis: possibly induced with a nonrandom geographic distribution. Cancer Genet Cytogenet. 1984 Aug. 12(4):283-94. [Medline].

  79. Schulman I, Pierce M. Studies on thrombopoiesis.I.A factor in normal plasma required for platelet production; chronic thrombocytopenia due to its deficiency. Blood. 1960. 16:943.

  80. Scoazec JY, Imbert M, Crofts M, et al. Myelodysplastic syndrome or acute myeloid leukemia? A study of 28 cases presenting with borderline features. Cancer. 1985 May 15. 55(10):2390-4. [Medline].

  81. Silverman LR, Mufti GJ. Methylation inhibitor therapy in the treatment of myelodysplastic syndrome. Nat Clin Pract Oncol. 2005 Dec. 2 Suppl 1:S12-23. [Medline].

  82. Sun EC, Yen YM, Ip T, Otsuka NY. Peripheral circulation in patients with myelodysplasia. J Pediatr Orthop. 2003 Nov-Dec. 23(6):714-7. [Medline].

  83. Takagi S, Tanaka O, Origasa H, Miura Y. Prognostic significance of magnetic resonance imaging of femoral marrow in patients with myelodysplastic syndromes. J Clin Oncol. 1999 Jan. 17(1):277-83. [Medline].

  84. Tricot G, De Wolf-Peeters C, Hendrickx B, Verwilghen RL. Bone marrow histology in myelodysplastic syndromes. I. Histological findings in myelodysplastic syndromes and comparison with bone marrow smears. Br J Haematol. 1984 Jul. 57(3):423-30. [Medline].

  85. Tricot G, De Wolf-Peeters C, Vlietinck R, Verwilghen RL. Bone marrow histology in myelodysplastic syndromes. II. Prognostic value of abnormal localization of immature precursors in MDS. Br J Haematol. 1984 Oct. 58(2):217-25. [Medline].

  86. Tricot G, De Wolf-Peeters C, Vlietinck R, Verwilghen RL. The importance of bone marrow biopsy in myelodysplastic disorders. Bibl Haematol. 1984. (50):31-40. [Medline].

  87. Woodard P, Barfield R, Hale G, et al. Outcome of hematopoietic stem cell transplantation for pediatric patients with therapy-related acute myeloid leukemia or myelodysplastic syndrome. Pediatr Blood Cancer. 2005 Sep 9. [Medline].

  88. Woods WG, Barnard DR, Alonzo TA, et al. Prospective study of 90 children requiring treatment for juvenile myelomonocytic leukemia or myelodysplastic syndrome: a report from the Children's Cancer Group. J Clin Oncol. 2002 Jan 15. 20(2):434-40. [Medline].

  89. Woolfrey AE, Gooley TA, Sievers EL, et al. Bone marrow transplantation for children less than 2 years of age with acute myelogenous leukemia or myelodysplastic syndrome. Blood. 1998 Nov 15. 92(10):3546-56. [Medline]. [Full Text].

  90. Yoshida Y, Oguma S, Uchino H, Maekawa T. Refractory myelodysplastic anaemias with hypocellular bone marrow. J Clin Pathol. 1988 Jul. 41(7):763-7. [Medline]. [Full Text].

  91. Yusuf U, Frangoul HA, Gooley TA, et al. Allogeneic bone marrow transplantation in children with myelodysplastic syndrome or juvenile myelomonocytic leukemia: the Seattle experience. Bone Marrow Transplant. 2004 Apr. 33(8):805-14. [Medline].

 
Previous
Next
 
Morphological findings of refractory cytopenia of childhood.
Morphological findings of hypoplastic refractory cytopenia of childhood and aplastic anemia of childhood.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.