Chronic Myeloid Neoplasms
Myelodysplastic syndromes
Alkylating agents causing therapy related myelodysplastic syndrome

Author: Nikhil Sangle, M.D. (see Authors page)

Revised: 27 February 2017, last major update August 2011

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: "Alkylating agents" AND "therapy related myelodysplastic syndrome"

See also: Therapy related myelodysplastic syndrome
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Cite this page: Alkylating agents causing therapy related myelodysplastic syndrome. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/myeloproliferativetherapyMDSalkylatingagents.html. Accessed April 22nd, 2019.
Definition / general
  • Occurs median 5 years after initiation of therapy
  • Risk is associated with patient age and cumulative dose of alkylating agent
  • Typically presents with myelodysplastic syndrome and bone marrow failure
  • Poor prognosis; median survival is 7 - 8 months; may progress to AML or die without progression
Microscopic (histologic) description
  • Peripheral blood: one or more cytopenias, anemia with macrocytosis and poikoilocytosis, dysplastic changes in neutrophils
  • Bone marrow: hypercellular, normocellular or hypocellular marrow
  • Often severely dysplastic changes in blood and marrow affecting two or more lineages
  • Myelofibrosis (15% cases) and ringed sideroblasts common; < 5% myeloblasts
Microscopic (histologic) images

Images hosted on PathOut server:


Peripheral blood:

Postchemotherapy for breast cancer,
erythrocytes have anisopoikilocytosis
with numerous macrocytes, large red cell
precursor has marked nuclear lobulation


Bone marrow smear:

Numerous red cell precursors
with marked nuclear lobulation,
no increased myeloblasts

Molecular / cytogenetics description
  • Abnormalities of chromosomes 5 or 7 or complex cytogenetic abnormalities; also AML1 mutations (Blood 2004;104:1474)
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