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Key Clinical Message  Assiduous surveillance for genetic aberrations is necessary in patients on cytotoxic therapies to detect therapy‐related myeloid neoplasms (t‐ MN ). Current modalities include metaphase cytogenetics and  FISH . Since t‐ MN  may develop abruptly in cytogenetically normal patients, a discussion exploring additional methods such as  SNP ‐array and targeted‐deep‐sequencing to detect subchromosomal abnormalities is needed.

Fulminant onset of acute leukemia from normal hematopoiesis within 3 months of follow up for multiple myeloma treated with total therapy protocols