Therapy Related Myeloid Neoplasms
Definition
- Myeloid neoplasms arising as complications of chemotherapy or radiation therapy
Diagnostic Criteria
- Myeloid neoplasms arising as complications of therapy should be classified separately due to their generally poor prognosis
- Category includes development of:
- Therapy related acute myeloid leukemia (tAML)
- Therapy related myelodysplastic syndromes (tMDS)
- Therapy related myelodysplastic/myeloproliferative neoplasms (tMDS/MPN)
- Transformation of myeloproliferative neoplasms is excluded
- Morphologic features are those of the corresponding non-treatment related disorders
- See specific diseases for criteria (Classification/Lists)
- Morphologic subclassification, including blast percentage, not as prognostically important as in de novo myeloid neoplasms
- Most develop 1-10 years post therapy (see Clinical)
- Associated with treatment of a variety of prior disorders
- Cytogenetics highly prognostic – (see Supplemental Studies)
- By contrast, the WHO categories for de novo myeloid neoplasms do not identify significantly better prognosis subgroups
- Special differential diagnostic considerations:
- De novo myeloid neoplasia
- Transient mild dyspoiesis in the setting of ongoing or recent chemotherapy
- For both, correlate with cytogenetic studies (see Supplemental Studies) and clinical course
Dita Gratzinger MD PhD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342
Original posting: 12/17/11
