b'The mutational spectrum is similar between Agent Orange exposed and control MDS patients. (a) Co-mutation plot for driver mutations identified in Agent Orange exposed and control subjects. Syn: synonymous. (b) Mutational signature analysis for subjects exposed to Agent Orange and controls. Colored chart signifies the specific single nucleotide variant and 44 grid denotes the sequence context. (c) Mutational burden per Mbp for Agent Orange exposed veterans compared to controls.Source: Menssen AJ, Walter MJ. Genetics of progression from MDS to secondary leukemia. Blood. 2020 Jul 2;136(1):50-60. doi: 10.1182/blood.2019000942. PMID: 32430504; PMCID: PMC7332895.of 45, with an average age of diagnosis of about 68.associated with OS (p-value = 0.0548). The hazard It does sometimes occur in children, however. of death for those in the military is 2.36 times higher One study raised the possibility that AML in vet- for patients with AML relative to civilians (95% CI: erans might be linked to exposure of military toxici- 0.98, 5.69), the authors noted.ties in general, not just Agent Orange, and that thoseResearchers concluded that patients who served in exposures affected survival rates. the military may have lower OS compared to those For the presentation at the 2016 American Society ofwho have not. This finding may be related to unmea-Clinical Oncology Annual Meeting, researchers fromsured exposure to potential carcinogens, and called theOklahomaUniversityHealthSciencesCenterfor more research on the issue.retrospectively analyzed all adult patients diagnosed with AML and treated at the University of OklahomaMyelodysplastic SyndromesfromJanuary2000toJune2012.ResponseswereA 2020 study from the Dana-Farber Cancer Institute received from 181 patients or next-of-kin, with most,and the Broad Institute of MIT and Harvard, both 61%, men with a median age of 52. 2 in the Boston area, looked at myelodysplastic syn-Those patients had a median overall survival of 27dromes (MDS) occurring in Agent Orange-exposed months, and most patients reported good family sup- individuals carrying a mutational spectrum similar port (65%), having not served in the military (94%),to that of de novo MDS. It did not find clear evidence or having difficulty with travel (73%). that toxic exposure led to the condition. 3After adjusting for age and cytogenetic risk, theCharacterizedbybloodcytopenias,dysplas-researchers found that military status was marginallytichematopoieticdifferentiationandariskof Continued on Page 62 u55'