With advances in the diagnosis and treatment of female-specific cancers such as breast and ovarian cancer, the survival rate of patients has increased significantly, but the risk of therapy-related myeloid neoplasms (t-MN), a severe long-term complication, has become increasingly prominent. T-MN includes therapy-related acute myeloid leukemia and myelodysplastic syndromes, which are more complex and have a poorer prognosis than primary myeloid neoplasms.
Current t-MN treatment faces multiple dilemmas: traditional chemotherapy has limited efficacy, and hematopoietic stem cell transplantation is restricted by multiple factors, benefiting only a small number of patients. Thus, deciphering its pathogenesis and exploring precise diagnosis and treatment plans are particularly crucial.
The review points out that the occurrence of t-MN is the result of the synergistic effect of multiple factors, including treatment exposure, genetic susceptibility, acquired mutations, and abnormal hematopoietic microenvironment. Common treatments such as alkylating agents, topoisomerase II inhibitors, as well as PARP inhibitors and radiotherapy, may induce t-MN by interfering with DNA repair and other mechanisms. Some patients carry germline mutations such as TP53 and BRCA1/2, somatic mutations accelerate disease progression, clonal hematopoiesis is an important early warning signal, and abnormal hematopoietic microenvironment also participates in the process.
In terms of prevention and treatment, the review proposes a female-focused management plan: pre-treatment risk stratification through genetic testing and clonal hematopoiesis assessment, individualized treatment adjustment during therapy, and regular monitoring of high-risk groups after treatment to achieve early detection and intervention. Meanwhile, new therapies such as CPX-351, hypomethylating agents combined with targeted drugs, as well as the exploration of cutting-edge technologies like CAR-T and Menin inhibitors, bring new treatment hopes to patients.
The long-term health management of female cancer survivors needs to balance tumor control and long-term complication prevention. This review establishes a complete framework for the precise prevention and control of t-MN. With continuous technological breakthroughs in the future, it is expected to realize full-process precise management and build a solid long-term health barrier for female patients.
Medicine Plus
Literature review