The vast majority of MDS cases are primary; that is, they have no known predisposing event. Epidemiological studies have reported weak associations between MDS and smoking, petroleum exposure, organic solvents, fertilizers, and arsenic and thallium. Inherited gene mutations (e.g. AML1 and NF1; see below) probably account for a very small number of cases. Studies of polymorphic gene variants are in progress but as yet no definitive associations have been reported. Some cases of MDS relate to previous treatment with chemotherapy, particularly alkylating agents or topoisomerase inhibitors; these are the secondary MDS. In addition, MDS is seen following bone marrow transplantation; for example, autologous bone marrow transplantation for non-Hodgkin's lymphoma.
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