“…4 Although numerous risk factors have been identified (male gender, smoking, hair dyes, pesticides, herbicides, organic chemicals, heavy metals, benzene, and other solvents), a clear association with any of these predisposing factors is reported to be found in only 20 -30% of patients (secondary MDS). [5][6][7][8][9] Treatment-related MDS (t-MDS) after exposure to bone marrow-damaging agents such as chemotherapy drugs or ionizing radiation has received the most attention. 10 -12 Secondary MDS and t-MDS differ from primary MDS, in that the age of onset is approximately 10 years earlier, dysplasia is more prominent, cytopenias are more severe, disease progression is more rapid, and outcomes are worse.…”