The MDSs are a clonal stem cell disorder, resulting from a lesion in the stem cell that leads to the formation of an abnormal clone of cells, a neoplasm. There are two types of MDS: de novo (new cases unrelated to any other treatment) and secondary cases related to prior therapy, usually alkylating therapy or radiation. Certain populations are at risk for MDS: those individuals exposed to benzene, radiation petrochemical employees, cigarette smokers, and patients with Fanconi's anemia.2 Secondary cases are often seen following immunosuppressive therapy, and the transformation to MDS may occur within 2 to 5 years after the agent or agents have been administered.3 From 30% to 40% of all MDS cases end in an acute leukemia.4

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