Leukemia - Acute
Recurrent genetic abnormalities
Myeloid neoplasms due to alkylating agents

Author: Daniela Mihova, M.D. (see Authors page)

Revised: 30 March 2018, last major update February 2013

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PubMed Search: Myeloid neoplasms [title] due to alkylating agents

Related Topics: Therapy related myeloid neoplasms

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Cite this page: Mihova, D. Myeloid neoplasms due to alkylating agents. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/leukemiaamltherapyrelatedalkylating.html. Accessed November 14th, 2019.
Definition / general
  • Alkylating agents: busulfan, carboplatin, carmustine, chlorambucil, cisplatin, cyclophosphamide, dacarbazine, lomustine, melphalan, mitocyn C, nitrogen mustard, procarbazine, thiotepa
  • Occurs median 5 years after initiation (range 2 - 11 years)
  • Risk is associated with patient age and cumulative dose of alkylating agent
  • Typically presents with myelodysplastic syndrome and bone marrow failure
  • May progress to AML or may die without progression
Prognostic factors
  • Poor prognosis (worse than de novo AML with comparable features); median survival is 7 - 8 months
  • Survival < 1 year if abnormalities of #5, #7 or complex changes
Microscopic (histologic) description
  • Presents as MDS, AML or MDS/MPN (CMML)
  • Hypocellular marrow; severe dysplastic changes in blood and marrow in 60%
  • Basophilia, myelofibrosis and ringed sideroblasts common (> 15%)
  • In MDS phase (50%), < 5% myeloblasts
  • Primary neoplasm may persist in conjuction with therapy related myeloid neoplasm
Molecular / cytogenetics description
  • Abnormalities of chromosomes 5 or 7 or complex cytogenetic abnormalities
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