Therapy-related myelodysplastic syndromes, or are they?

Anti‐tuberculosis agents may be associated with myelodysplastic syndromes

“…A, The findings on a chest X-ray image obtained before TB treatment, with bilateral pleural effusion in the lower lungs; B, dysplasia of myeloid cell (arrow); C, dysplastic red blood cell with budding of nuclei and internuclear bridging (arrow); D, dysplastic megakaryocyte with two nuclei (arrow) hematologic and solid malignancies; both radiation and cytotoxic chemotherapy have been associated with t-MDS. 1 About 10% to 20% of cases of therapy-related myeloid neoplasm/MDS occur in patients treated receiving radiotherapy or chemotherapy. 2 Patients with stomach, colorectal, liver, breast, endometrial, prostate, and kidney cancers who receive therapeutic radiation therapy seem to be at a significantly higher risk of developing t-MDS, and patients treated with chemotherapy for their primary malignancy have an increased risk of t-MDS.…”

“…2 Patients with stomach, colorectal, liver, breast, endometrial, prostate, and kidney cancers who receive therapeutic radiation therapy seem to be at a significantly higher risk of developing t-MDS, and patients treated with chemotherapy for their primary malignancy have an increased risk of t-MDS. 1 Approximately 16.6% of patients who received first-line anti-TB drugs developed leukopenia after 8 weeks. 3 t-MDS has been reported in patients who received rifampicin.…”

Representation of therapy-related myelodysplastic syndrome in clinical trials over the past 20 years

“…It constitutes ;10% to 20% of all MDS cases. 1,[4][5][6][7][8] The incidence rate of t-MDS is estimated to increase by 2% annually as a result of increased use of chemotherapy and radiotherapy and extended survival of patients with prior malignancies treated with these modalities. 9 Exposure to any cytotoxic or radiation anticancer therapy leads to a 0.24% to 5.4% lifetime risk of developing t-MDS.…”

“…9 Exposure to any cytotoxic or radiation anticancer therapy leads to a 0.24% to 5.4% lifetime risk of developing t-MDS. 4,9,10 Other factors, including preexisting somatic or germ line mutations, age at diagnosis, and smoking history, further increase this risk. 4 Compared with de novo MDS patients, those with t-MDS present with a higher frequency of high-risk genetic abnormalities or bone marrow blasts, 4,10 leading to worse overall survival (19 months) than that of de novo MDS patients (46 months).…”

“…Patients with a history of chemotherapy or radiotherapy for another cancer may present with MDS that is coincidentally de novo (eg, del20q and DNMT3A mutation as the only clonal drivers), whereas others without such a therapy history are likely to have exposure-related MDS based upon their presentation with a complex karyotype, TP53 mutations, and other characteristics more frequently seen in patients with therapy-related disease. 4,12 Secondly, the latency period between exposure and development of t-MDS is variable, ranging from ,2 years to a decade or more. 4,12 Ideally, a clinical trial should generate evidence supporting the use of novel therapies applicable across broad patient populations.…”