Refractory anemia with excess blasts in transformation

Refractory anemia with excess blasts in transformation (RAEB-T) is a subtype of myelodysplastic syndrome (MDS), a group of clonal hematologic disorders characterized by ineffective blood cell production (hematopoiesis) in the bone marrow. RAEB-T was originally classified under the French-American-British (FAB) classification system and is defined by the presence of 20–30% blasts (immature blood cells) in the bone marrow, or the presence of Auer rods in blast cells, or more than 5% blasts in the peripheral blood. Under the current World Health Organization (WHO) classification, cases previously categorized as RAEB-T are now generally reclassified as acute myeloid leukemia (AML). The disease primarily affects the hematopoietic (blood-forming) system, leading to bone marrow failure and cytopenias. Patients with RAEB-T typically present with symptoms related to low blood counts, including fatigue, weakness, and pallor due to anemia; increased susceptibility to infections resulting from neutropenia (low white blood cells); and easy bruising or bleeding caused by thrombocytopenia (low platelet counts). Some patients may experience fevers, weight loss, or an enlarged spleen. The condition carries a high risk of progression to overt acute myeloid leukemia and is associated with a poor prognosis, with median survival often measured in months without treatment. Treatment options for RAEB-T include supportive care such as blood transfusions and antibiotics, hypomethylating agents (azacitidine and decitabine), and intensive chemotherapy regimens similar to those used for AML. Allogeneic hematopoietic stem cell transplantation remains the only potentially curative therapy and is considered for eligible patients, particularly younger individuals with suitable donors. The choice of treatment depends on the patient's age, overall health, and cytogenetic risk profile.

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