Published online Aug 26, 2016. doi: 10.4252/wjsc.v8.i8.231
Peer-review started: May 28, 2016
First decision: July 6, 2016
Revised: July 21, 2016
Accepted: August 6, 2016
Article in press: August 8, 2016
Published online: August 26, 2016
Therapy-related myeloid neoplasms are neoplastic processes arising as a result of chemotherapy, radiation therapy, or a combination of these modalities given for a primary condition. The disease biology varies based on the etiology and treatment modalities patients receive for their primary condition. Topoisomerase II inhibitor therapy results in balanced translocations. Alkylating agents, characteristically, give rise to more complex karyotypes and mutations in p53. Other etiologies include radiation therapy, high-dose chemotherapy with autologous stem cell transplantation and telomere dysfunction. Poor-risk cytogenetic abnormalities are more prevalent than they are in de novo leukemias and the prognosis of these patients is uniformly dismal. Outcome varies according to cytogenetic risk group. Treatment recommendations should be based on performance status and karyotype. An in-depth understanding of risk factors that lead to the development of therapy-related myeloid neoplasms would help developing risk-adapted treatment protocols and monitoring patients after treatment for the primary condition, translating into reduced incidence, early detection and timely treatment.
Core tip: Therapy-related myeloid neoplasms are becoming an increasing problem as the survival of cancer patients lengthens. The etiology has an important influence on the biological characteristics, time to onset and prognosis of the resultant disease. Although treatment of therapy-related myeloid neoplasms represents a substantial challenge due to prior treatment and comorbidities, cure is possible, especially with allogeneic stem cell transplantation, particularly in those with good-risk karyotype. Ultimately, individual assessment of risk factors may lead to developing risk-adapted therapies to reduce the incidence of this serious complication without affecting therapy for the underlying disorders.