Search Database ICD-O-3 Code Lists

Name

Myeloid neoplasm post cytotoxic therapy (MN-pCTs)

ICD-O-3 Morphology

9920/3: Therapy related myeloid neoplasm
Effective 2001 and later

Reportable

for cases diagnosed 1978 and later

Primary Site(s)

C421
Primary site must be bone marrow (C421)

Coding Manual: Hematopoietic Coding Manual (PDF)

Abstractor Notes

Myeloid neoplasm post cytotoxic therapy (MN-pCTs) is part of the Secondary myeloid lineage table in the WHO 5th edition of Hematolymphoid Tumors. (See Appendix B in the Hematopoietic Manual, Table B7)

Blood and bone marrow are primarily involved. Rare presentation as myeloid sarcoma can occur.

DO NOT code therapy-related myeloid neoplasm simply because the patient has a history of radiation therapy or chemotherapy. There must be a physician's statement that says this is a therapy-related neoplasm (acute myeloid leukemia, MDS, MPN, or MDS/MPN.)

If a specific myeloid neoplasm that is described with a different specific histology term is also stated to be therapy related, code 9920/3 to capture the fact that this disease was therapy related. Document the other specific histology term in the text part of the abstract.

If this leukemia and myeloid sarcoma (9930/3) occur during the same clinical workup, this is one primary, the leukemia.

If the myeloid sarcoma occurs after the diagnosis of the leukemia, that is a manifestation of the leukemia and is the same primary.

See Multiple Primary Rule M3

Diagnostic Confirmation

This histology can be determined by positive histology (including peripheral blood) with or without genetics and/or immunophenotyping. Review the Definitive Diagnostic Methods, Immunophenotyping and Genetics Data sections below, and the instructions in the Hematopoietic Manual for further guidance on assigning Diagnostic confirmation.

Module Rule

None

Alternate Names

Acute myeloid leukemia post cytotoxic therapy
Myelodysplastic neoplasm post cytotoxic therapy (therapy related), alkylating agent related
Myelodysplastic neoplasm post cytotoxic therapy (therapy related), epipodophyllotoxin agent related
Myelodysplastic/myeloproliferative neoplasm post cytotoxic therapy (therapy related)
Therapy-related acute myeloid leukemia, NOS
Therapy-related myelodysplastic syndrome
Therapy-related myeloid neoplasm

Definition

Myeloid neoplasms post cytotoxic therapy (MN-pCTs) include myelodysplastic neoplasms (MDSs), myelodysplastic/myeloproliferative neoplasms (MDS/MPNs), and acute myeloid leukemia (AML) that arise in a patient with a history of exposure to DNA-damaging cytotoxic chemotherapy and/or large-field radiation therapy. (WHO 5th edition)

Definitive Diagnostic Methods

Clinical diagnosis
Immunohistochemistry
Immunophenotyping
Cytogenetics
Genetic testing
Histologic confirmation

Genetics Data

Predominant complex karyotypes (loss of 5q, 7q and 17p)
Frequent complex karyotypes (loss of 12 p, 13q, 18q, 20q, gain of 1q and 21q)
Frequent TP53 deletions/mutations

Immunophenotyping

C19+ (expression/positive)
cC79a+ (expression/positive)
cCD3+ (expression/positive)
CD5+ (expression/positive)
CD7+ (expression/positive)
CD25+ (expression/positive

Treatments

Chemotherapy
Hematologic Transplant and/or Endocrine Procedures
Immunotherapy
Radiation therapy

Transformations to

Transformations from

None

Same Primaries

Corresponding ICD-10 Codes (Cause of Death codes only)

C92.0 Acute myeloid leukemia

Corresponding ICD-10-CM Codes (U.S. only)

C92.0 Acute myeloblastic leukemia (effective October 01, 2015 - September 30, 2024)
C92.00 Acute myeloblastic leukemia not having achieved remission (effective October 01, 2024)
C92.01 Acute myeloblastic leukemia, in remission (effective October 01, 2024)
C92.02 Acute myeloblastic leukemia, in remission (effective October 01, 2024)

Signs and Symptoms

Bone marrow failure
Cytopenia
Easy bruising or bleeding
Fatigue
Fever
Petechiae
Shortness of breath
Weakness
Weight loss or loss of appetite

Diagnostic Exams

Bone marrow aspiration and biopsy
CT (CAT) scan
Cytogenetic analysis
Immunophenotyping
Lumbar puncture
Peripheral blood smear
Physical exam and history
Flow cytometry
Molecular analysis

Progression and Transformation

None

Epidemiology and Mortality

Incidence: 10-20% of all cases of AML, MDS and MDS/MPN
Survival: 5 year survival less than 10%

Sources

WHO Classification of Tumours Editorial Board. Haematolymphoid tumours. Lyon (France): International Agency for Research on Cancer; 2024. (WHO classification of tumours series, 5th ed.; vol. 11). https://publications.iarc.who.int/637.
Section: Myeloid neoplasms and proliferations
Pages: Part A: 170-172

International Classification of Diseases for Oncology, 3rd edition (including revisions). Geneva: World Health Organization, 2001, 2011, 2020.
Section: ICD-O-3.2 (2020) Morphological Codes
Pages: http://www.iacr.com.fr/index.php?option=com_content&view=category&layout=blog&id=100&Itemid=577

PDQ® Adult Treatment Editorial Board. PDQ Acute Myeloid Leukemia Treatment. Bethesda, MD: National Cancer Institute. Updated <03/06/2024>. Available at: https://www.cancer.gov/types/leukemia/hp/adult-aml-treatment-pdq. Accessed <02/06/2025>. [PMID: 26389432]
Section: Acute Myeloid Leukemia Treatment (PDQ®)–Health Professional Version
Pages: https://www.cancer.gov/types/leukemia/hp/adult-aml-treatment-pdq
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