title: Good riddance to the term "refractory anemia" in myelodysplastic syndromes.
abstract: The term "refractory anemia" was used in 1937 by Cornelius Parker Rhoads to describe patients whose anemia did not improve after treatment with liver extract or iron salts, and this term has been used to denote patients with certain subtypes of myelodysplastic syndromes (MDS) since the 1976 and 1982 French-American-British (FAB) classifications of acute leukemias and MDS. In 2016, the World Health Organization (WHO) proposed elimination of "refractory anemia" in a more general proposal for reclassification of myeloid neoplasia. A scandal relating to Dr. Rhoads' possibly unethical medical experiments on anemic patients in Puerto Rico in 1931 and a racially offensive letter he wrote during that period prompted an international incident and Congressional-level inquiry. This dark history, as well as continued terminological problems with refractory anemia, suggest that this hoary term has indeed worn out its usefulness. This article reviews the history of "refractory anemia" and evolution in its use over the past 80 years. Rhoads' personal history, the potentially confusing nature of "refractory anemia", and the fact that it is possible none of the 100 patients Rhoads described in 1937 actually had MDS all support the new WHO reclassification proposal to eliminate this term.
authors: Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA USA. Electronic address: David_Steensma@DFCI.HARVARD.EDU.
authors: David P
authors: DP
authors: Steensma
mesh_terms: D000753:Anemia, Refractory / Q000145:classification / Q000266:history*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D009190:Myelodysplastic Syndromes / Q000145:classification / Q000266:history*; D009626:Terminology as Topic; D014944:World Health Organization
keywords: Cornelius Packard Rhodes; Disease classification; Medical ethics; Myelodysplastic syndromes; Puerto Rico; Racism; Refractory anemia; WHO classification