17: Management of Therapy-Related Myeloid Neoplasms

Management of Therapy-Related Myeloid Neoplasms

Jagoda K. Jasielec and Richard A. Larson

The University of Chicago, Chicago, IL, USA


Therapy-related myeloid neoplasms (t-MNs) are clonal disorders of hematopoietic stem cells that occur following prior treatment with cytotoxic chemotherapy and/or ionizing radiation. This clinical syndrome is a spectrum of disorders that includes myelodysplastic syndrome (t-MDS), acute myeloid leukemia (t-AML), and myelodysplastic and myeloproliferative neoplasms (t-MDS/MPN). It is distinct from secondary leukemias that arise from antecedent hematologic disorders, such as primary MDS or myelofibrosis, or those leukemias that are second cancers appearing in the absence of prior cytotoxic exposure. t-MNs are estimated to represent approximately 10–20% of all newly diagnosed cases of MDS, AML, MDS/MPN, although the precise incidence is unknown. The latency period between first exposure and development of bone marrow dysfunction varies depending on the specific cytotoxic agents (alkylators, topoisomerase-II inhibitors, antimetabolites, or radiation) used, as well as the intensity and duration of exposure. The outcomes for patients with t-MN are inferior compared to those for patients with primary MDS or de novo AML; the median survival overall is approximately 9–10 months. The causes for increased mortality are many and include a higher incidence of unfavorable cytogenetics, persistence of the primary malignancy, chronic organ injury and poor bone marrow reserve from prior therapies, alloimmunization affecting further transfusion support, as well as chemotherapy resistance related to prior exposures. In this chapter, we discuss the diagnosis and management of t-MN, which are illustrated by commonly encountered scenarios in clinical practice.

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Jul 8, 2016 | Posted by in ONCOLOGY | Comments Off on 17: Management of Therapy-Related Myeloid Neoplasms

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