Myeloid Neoplasms Postcytotoxic Therapy in Children

Myeloid neoplasms postcytotoxic therapy (MN-pCT) in children represent a heterogeneous group of neoplasms which primarily arise following exposure to alkylating agents, topoisomerase inhibitors, and radiotherapy. Outcomes remain poor despite aggressive chemotherapeutic approaches and allogeneic hematopoietic stem cell transplantation (HSCT). Although there are shared features between childhood and adult-onset disease, recent studies of pediatric onset MN-pCT suggest unique pathophysiology with distinctive genomic features and lack of pre-existing clonal hematopoiesis clones susceptible to transformation. Future studies prospectively evaluating the utility of tracking molecular evidence of development of MN-pCT in children exposed to cytotoxic agents could lead to early detection and potentially more effective interventions for patients.