It is generally agreed that ineffective hemopoiesis in MDS is caused by excessive apoptosis of myeloid precursors. An illustrative study is that of Huh and colleagues (2002), which showed more cell death in refractory anemia with excess blasts in transformation than in acute myeloid leukemia. It is postulated that apoptosis is a reactive phenomenon caused by cytokines. The progression of MDS to leukemia is associated

Critical region of the 5q- syndrome q11

q14 q15 q21 q22 q23








Critical region of gene loss ~1.5 Mb

Fig. 8.2 Diagrammatic representation of the long arm of chromosome 5 showing the position of the critical region of gene loss and some of the genes within this region

Interestingly the expression of the anti-apoptotic gene sur-vivin has been shown to be common in RA (11/12 patients) and undetectable in CMML (0/4 patients).

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