Therapy-Related Myeloid Malignancies in

Therapy related myeloid malignancies are an increasingly recognized treat complication in patients undergoing therapy for multiple myeloma. The main predisposing factors are the alkylating agents, topoisomerase II inhibitors and radiotherapy, but recently questions have been raised regarding the immunomodulatory agent lenal antimyeloma agents in the context of therapy related myeloid malignancies. The duration of treatment and the time from diagnosis are the main contributing factors in alkylating induced myeloid malignancies which occur being the characteristic finding. High dose therapy (HDT) does not seem to be a major contributing factor per se in multiple myeloma. In a number of large published series, all the factors relat therapy-induced myelodysplasia were defined prior to HDT. Topoisomerase II inhibitors induce mainly acute leukemias which invariably correlate with dysregulation of the MLL gene. Radiotherapy causes therapy related myelodysplasia if applied in bone especially if combined with chemotherapy. Therapy related myeloid malignancies generally herald a poor prognosis. Karyotypic abnormalities seem to be the main prognostic factor. In all cases the risk for therapy related myeloid mal Introduction. The problem of therapy related myelodysplastic syndromes (t-MDS) and acute myeloid leukemia (t-AML) in the context of cytotoxic chemotherapy is perhaps as old as the cytotoxic chemotherapy itself and it is part of the more general problem of the second malignancies after cytotoxic chemotherapy. It is a well known fact that as the overall survival (OS) for a malignant disease increases due to the treatment done, so the late effects of this www.mjhid.org ISSN 2035-3006