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Name
Therapy-related myeloid neoplasms
ICD-O-3 Morphology
9920/3: Therapy related myeloid neoplasm
Effective
2001 and later
Reportable
for cases diagnosed
2001 and later
Primary Site(s)
C421
Primary site must be bone marrow (C421)
Coding Manual:
Hematopoietic Coding Manual (PDF)
Abstractor Notes
For cases abstracted prior to 2010, this code was only used for therapy-related Acute myeloid leukemia (t-AML).
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.
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.
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.
Grade
Not Applicable
Module Rule
None
Alternate Names
Secondary MDS
t-AML
t-AML/t-MDS
t-MDS
t-MDS/MPN
Therapy-related myelodysplastic syndrome
Therapy-related myelodysplastic/myeloproliferative neoplasm
Definition
Therapy-related myeloid neoplasms (t-MNs) include therapy-related cases of acute myeloid leukemia (t-AML), myelodysplastic syndromes (t-MDS), and myelodysplastic/myeloproliferative neoplasms (t-MDS/MPN) that occur as a late complication of cytotoxic chemotherapy and/or radiation therapy administered for a prior neoplastic or non-neoplastic disorder.
Although cases may be diagnosed morphologically as t-MDS, t-MDS/MPN, or t-AML according to the number of blasts in the blood and/or bone marrow, these t-MNs are best grouped together as a unique clinical syndrome distinguished by prior iatrogenic exposure to mutagenic agents.
Excluded from this category are progression of MPNs and evolution of primary MDS or primary MDS/MPN to AML; in each of these latter cases evolution to AML is part of the natural history of the primary disease and it may be impossible to distinguish natural progression from therapy-related changes.
Although cases may be diagnosed morphologically as t-MDS, t-MDS/MPN, or t-AML according to the number of blasts in the blood and/or bone marrow, these t-MNs are best grouped together as a unique clinical syndrome distinguished by prior iatrogenic exposure to mutagenic agents.
Excluded from this category are progression of MPNs and evolution of primary MDS or primary MDS/MPN to AML; in each of these latter cases evolution to AML is part of the natural history of the primary disease and it may be impossible to distinguish natural progression from therapy-related changes.
Definitive Diagnostic Methods
Bone marrow biopsy
Genetic testing
Immunophenotyping
Genetics Data
del(3p)
del (13q)
del(20q)
del(11q)
FLT3
Gain of chormosome 8
IDH1/2
Loss of chromosomes 5q, 7, 17, 17p, 18, 21
NRAS
PTPN11
TET2
TP53 loss
Immunophenotyping
CD13 expression
CD33 expression
CD34 positive
MPO expression
Treatments
Chemotherapy
Hematologic Transplant and/or Endocrine Procedures
Immunotherapy
Radiation therapy
Transformations to
Transformations from
None
Same Primaries
Corresponding ICD-9 Codes
205.0 Acute myeloid leukemia
Corresponding ICD-10 Codes
C92.0 Acute myeloid leukemia
Corresponding ICD-10-CM Codes (U.S. only)
C92.0 Acute myeloblastic leukemia (effective October 01, 2015)
Signs and Symptoms
Diagnostic Exams
CT (CAT) scan
Cytogenetic analysis
Immunophenotyping
Lumbar puncture
Peripheral blood smear
Physical exam and history
Reverse transcription-polymerase chain reaction test (RT-PCR)
Progression and Transformation
None
Epidemiology and Mortality
Sources
Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J (Eds):
WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues (Revised 4th edition)
IARC: Lyon 2017
Section: Acute myeloid leukemia and related precursor neoplasms
Pages: 153-155
WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues (Revised 4th edition)
IARC: Lyon 2017
Section: Acute myeloid leukemia and related precursor neoplasms
Pages: 153-155
International Classification of Diseases for Oncology, Third Edition, Second Revision. Geneva: World Health Organization, 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
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
National Cancer Institute
Section: General Information About Acute Myeloid Leukemia
Pages: https://www.cancer.gov/types/leukemia/hp/adult-aml-treatment-pdq
Section: General Information About Acute Myeloid Leukemia
Pages: https://www.cancer.gov/types/leukemia/hp/adult-aml-treatment-pdq
