Post-cytotoxic myeloid neoplasms: a MENA region study of clinicopathologic, genetic profile, latency determinants and prognostic predictors
Post-cytotoxic myeloid neoplasms (MN-PCT), also known as therapy-related myeloid neoplasms (t-MN), represent a heterogeneous group of hematologic malignancies that develop after a patient receives cytotoxic chemotherapy or radiotherapy for an unrelated condition.
These disorders, which include therapy-related myelodysplastic syndrome (t-MDS), acute myeloid leukemia (t-AML), and myelodysplastic/myeloproliferative neoplasms (t-MDS/MPN) are notorious for their aggressive nature, universally poor survival, and a lack of consensus on reliable prognostic indicators. This complexity stems from a combination of the cytotoxic treatment effects, genetic instability, and patient-specific variables.
To address the limited understanding of this entity, a 10-year retrospective, single-center study was conducted at the National Center for Cancer Care and Research (NCCCR) in Qatar. Analyzing a cohort of 42 MN-PCT patients, this research offers the first comprehensive dataset on t-MN from the Middle East and North Africa (MENA) region.
The analysis revealed several critical findings. The most common genetic mutation was found in the TP53 gene, present in 28.6% of tested cases. Notably, the study found a high prevalence of autoimmune diseases (30.9%) as the original primary condition, a percentage higher than previously documented. A shorter latency period—the time from prior therapy to MN-PCT diagnosis—was significantly associated with previous exposure to alkylating agents and TP53 positivity. Patients aged 50 or younger demonstrated a longer median survival.
Researchers identified multiple factors affecting disease progression and patient outcome. Dyserythropoiesis, Myeloperoxidase downregulation, mutated TP53, and failure to achieve clinical remission were identified as poor prognostic markers. A latency period of ≥ 5 years and TP53 positivity were identified as statistically significant independent factors associated with reduced overall survival. P53 mutation was a common parameter that adversely impacted both MN-PCT survival and overall survival.
This study significantly advances the understanding of MN-PCT in an underrepresented population. The findings underscore the importance of recognizing MN-PCT as a distinct clinical and pathological entity in future classification systems, emphasizing that adverse prognostic factors extend beyond mere genetic influences.
Reference Source
Soliman, D.S., Fareed, S., Chandra, P. et al. (2025). Post-cytotoxic myeloid neoplasms: a comprehensive analysis of clinicopathologic, genetic profile, latency determinants, and potential prognostic predictors- a single centre study. Annals of Hematology. DOI: https://doi.org/10.1007/s00277-025-06651-0
