Therapy Related Myeloid Neoplasms
Clinical
- Most commonly associated with alkylating agents, topoisomerase II inhibotors and ionizing radiation
- May also occur with antimetabolites, antitubulin agents, radioiodine
- Associated with treatment of a variety of prior disorders
- Most are neoplasms, hematologic and non-hematologic
- May also be seen with treatment of non-neoplastic disorders
- May also be seen following chemotherapy with autologous hematopoietic stem cell transplant
- Two main presentation groups that may overlap
- Many patients have received multiple chemotherapeutic agents and are thus difficult to assign to the following groups
- About 70% of cases develop 5-10 years post therapy
- Associated with alkylating agents and/or ionizing radiation
- Most develop tMDS and bone marrow failure
- Fewer develop tMDS/MPN or tAML
- Primarily associated with unbalanced chromosomal abnormalities
- About 20-30% of cases develop 1-5 years post therapy
- Associated with topoisomerase II inhibitors
- Most present with tAML without an MDS phase
- Most associated with balanced chromosomal translocations
- Overall poor prognosis, median survival < 1 year
