An 8-year-old boy with short stature, café-au-lait macules, absent left thumb, and progressive pancytopenia is evaluated for suspected inherited bone marrow failure. His baseline karyotype is normal 46,XY, but peripheral blood lymphocytes cultured with diepoxybutane (DEB) and mitomycin C (MMC) demonstrate the cytogenetic pattern marked **A** in the diagram—markedly increased chromosomal breakage with radial, triradial, and quadriradial figures. Which of the following is the most likely diagnosis?
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