Atypical cytogenetics in therapy-related myelodysplastic syndrome secondary to indolent B-cell lymphoma

A case of therapy-related myelodysplastic syndrome (t-MDS) with unusual cytogenetics is presented. While therapy related myeloid neoplasms account for 10-20% of all myeloid neoplasms, 90% of therapy related myelodysplastic syndromes (MDS) present with a del(7q) or a del(5q) and fewer than 1% present with a del(20q). In this case, the common cytogenetic pattern of either del(7q) or del(5q) is absent while presenting with an abnormal del(20q). Also demonstrated is the potently poor prognostic indicator of cytomegalovirus (CMV) seropositivity, even when seropositivity is matched between donor and recipient of hematopoietic stem-cell transplant. The patient also continues to demonstrate the inherent dangers of a stem-cell transplant, presenting with graft-versus-host disease (GvHD) while being a haploidentical 10 out of 10 HLA match to the allogeneic stem cell donor.