Risk management process of t-MN in female-specific cancer. (IMAGE)
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It depicts a stepwise risk management process for t-MN in patients with female-specific cancers. The pre-treatment phase includes baseline evaluation of hematologic parameters, organ function, family history, primary tumor status, germline and somatic mutations (e.g., TP53, BRCA1/2, PPM1D), and hematologic risk factors such as CHIP, methylation status, and the bone marrow microenvironment. Treatment selection is then guided by risk-based stratification, aiming to balance primary cancer control with restriction of leukemogenic or DNA-damaging exposure and prioritization of lower mutagenic regimens, alongside routine blood count and smear monitoring. During and after treatment, further assessment for high‑risk of t‑MN should be undertaken when abnormalities are detected in routine blood tests or peripheral blood smears. This assessment includes documenting exposure to specific cytotoxic agents and radiotherapy, performing targeted hematologic evaluations, conducting timely bone marrow examinations, implementing dynamic CHIP monitoring, and detecting t‑MN‑related mutations and methylation changes.
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