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Therapy-related myelodysplastic syndrome — Clinical Guidelines

Overview

Therapy-related myelodysplastic syndrome (t-MDS) arises as a complication following exposure to cytotoxic chemotherapy or radiation therapy, often characterized by dysplastic changes in hematopoietic stem cells leading to ineffective hematopoiesis and a risk of progression to acute myeloid leukemia 5.

Diagnosis

Clinical Presentation: Symptoms include cytopenias (anemia, thrombocytopenia, neutropenia), recurrent infections, and bleeding 5.

Laboratory Tests: Peripheral blood smear showing dysplastic changes, bone marrow biopsy revealing dysplastic hematopoiesis 5.

Imaging and Biomarkers: Limited specific imaging; biomarkers like LDH and cytogenetic abnormalities may aid in assessment 5.

Management

Supportive Care: Blood transfusions, growth factors (e.g., G-CSF, erythropoietin) to manage cytopenias 5.

Symptom Management: Address specific cytopenia-related complications (e.g., antibiotics for infections) 5.

Prophylactic Measures: Avoidance of further cardiotoxic agents if history of cardiac toxicity; consider dexrazoxane for anthracycline-related cardiotoxicity 5 3.

Monitoring: Regular hematologic monitoring, including periodic bone marrow evaluations 5.

Special Populations

Elderly: Increased vulnerability to complications; tailored supportive care and close monitoring essential 5.

Comorbidities: Presence of cardiovascular disease may necessitate cautious use of cardiotoxic agents; consider risk stratification tools like HFA-ICOS score 3.

Key Recommendations

Regular Hematologic Monitoring: Frequent assessment of blood counts and bone marrow evaluations to detect early changes 5 (Evidence: Strong).

Risk Stratification: Utilize risk scores (e.g., HFA-ICOS) for patients receiving potentially cardiotoxic therapies to guide management 3 (Evidence: Moderate).

Supportive Therapies: Implement supportive measures such as transfusions and growth factors to manage cytopenias effectively 5 (Evidence: Strong).

Avoid Further Cardiotoxicity: Modify treatment regimens to avoid additional cardiotoxic agents in patients with existing cardiac dysfunction 5 (Evidence: Expert opinion).

References

1 Ali A, Clasen SC, Blaes A, Casselli S, Deswal A, Demeter SH et al.. Standardizing the Clinical Approach to Cancer Therapy-Related Cardiac Dysfunction: Applying Cardio-Oncology Guidelines as a Practical Tool for Hematology and Oncology Providers. Cancer medicine 2026. link 2 Donisan T, Sykora D, Balanescu DV, Chang IC, Lin G, Herrmann J et al.. Radionuclide imaging in cardio-oncology: A clinical decision-making tool. Progress in cardiovascular diseases 2025. link 3 Rivero-Santana B, Saldaña-García J, Caro-Codón J, Zamora P, Moliner P, Martínez Monzonis A et al.. Anthracycline-induced cardiovascular toxicity: validation of the Heart Failure Association and International Cardio-Oncology Society risk score. European heart journal 2025. link 4 Legallois D, Da Silva A, Alexandre J, Milliez P, Sabatier R, Blanchart K et al.. Identification of anticancer drugs associated to cancer therapy-related cardiac dysfunction: a VigiBase® disproportionality analysis. European heart journal. Cardiovascular pharmacotherapy 2025. link 5 Martinez-Dominguez P, Ana-Bayona MJS, Guerra EC, Espinola-Zavaleta N. Cancer Therapy-Related Cardiac Dysfunction: Strategies for Enhancing Cardiac Recovery. Methodist DeBakey cardiovascular journal 2024. link 6 Lee GA, Aktaa S, Baker E, Gale CP, Yaseen IF, Gulati G et al.. European Society of Cardiology quality indicators for the prevention and management of cancer therapy-related cardiovascular toxicity in cancer treatment. European heart journal. Quality of care & clinical outcomes 2022. link 7 Tong D, Zaha VG. Metabolic Imaging in Cardio-oncology. Journal of cardiovascular translational research 2020. link 8 Blumkin L, Leibovitz Z, Krajden-Haratz K, Arad A, Yosovich K, Gindes L et al.. Autosomal dominant TUBB3-related syndrome: Fetal, radiologic, clinical and morphological features. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society 2020. link 9 Totzeck M, Schuler M, Stuschke M, Heusch G, Rassaf T. Cardio-oncology - strategies for management of cancer-therapy related cardiovascular disease. International journal of cardiology 2019. link 10 Rhea I, Burgos PH, Fradley MG. Arrhythmogenic Anticancer Drugs in Cardio-Oncology. Cardiology clinics 2019. link 11 Campillos M, Kuhn M, Gavin AC, Jensen LJ, Bork P. Drug target identification using side-effect similarity. Science (New York, N.Y.) 2008. link 12 Eckardt K, Wagner C. Biosynthesis of anthracyclinones. Journal of basic microbiology 1988. link

Therapy-related myelodysplastic syndrome