Myeloid Neoplasms Post Cytotoxic Therapy in Chinese Patients: A Comprehensive Analysis

Background: Therapy-related myeloid neoplasms (MN-pCT) are serious long-term complications affecting cancer survivors. This study aimed to determine the incidence, characterize the clinical and genetic features, and assess outcomes along with prognostic factors in a cohort of Chinese patients with MN-pCT. Methods: We conducted a retrospective analysis of 460 patients diagnosed with myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) at our institution between 2008 and 2022. Among them, 31 patients met the diagnostic criteria for MN-pCT. The clinical parameters, prior treatment history, cytogenetic profiles, and mutational status were reviewed. Overall survival (OS) and disease-free survival (DFS) were calculated, and prognostic factors were identified using univariate and multivariate analyses. Results: The incidence of MN-pCT was 6.7%, with significantly poorer median OS than primary myeloid neoplasms (15 months for AML-pCT vs. 30 months for primary AML; 7 months for MDS-pCT vs. 47.5 months for primary MDS). Breast cancer was the most common prior malignancy. Univariate analysis identified advanced age (p p p p p p p < 0.0453) outcomes. Additionally, allogeneic stem cell transplantation (allo-SCT) was associated with improved survival, including in patients with high-risk features such as TP53 mutations. Conclusions: MN-pCT is associated with poor prognosis and a high frequency of adverse genetic abnormalities. The newly developed prognostic scoring system offers a practical tool for risk stratification. Allo-SCT represents a critical and potentially curative treatment option, highlighting the need for innovative approaches to expand transplant accessibility for more affected patients.