various risk factors have been implicated in the aetiology of MDS
these include age, male gender, alcohol, cigarette smoking, ionizing radiation, immunosuppressive therapy, viral infection, benzene and other environmental/occupational exposures
these risk factors are seen infrequently and are estimated to account for disease in only 20-30% of patients, who are often described as having secondary MDS
remainder of idiopathic cases constitute primary MDS
major subset of secondary MDS is therapy-related MDS (t-MDS) that is increasingly frequent in patients previously treated with chemotherapy and/or radiotherapy
t-MDS usually presents as high-risk disease that frequently progresses to AML, and is associated with a poor prognosis regardless of therapy
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