From November 6–9, 2025, the 2025 China Conference on Holistic Integrative Oncology (CCHIO) was held in Kunming. As one of the most influential oncology conferences in China, CCHIO gathered leading experts from across the globe to explore advances, challenges, and future directions in integrative cancer management.
During the meeting, Oncology Frontier – Hematology Frontier conducted an in-depth interview with Professor Tang Feifei of Peking University People’s Hospital, focusing on therapy-related myeloid neoplasms (t-MN). The discussion centered on epidemiological trends, disease characteristics, treatment strategy selection, current bottlenecks, and potential breakthroughs—aiming to provide clinical guidance for this highly challenging disease entity.
Q1
With the increasing variety of anti-cancer treatments, have therapy-related myeloid neoplasms shown new epidemiological trends in China? What unique challenges do t-MN present compared with de novo myeloid malignancies?
Professor Tang Feifei: As cancer survival improves, the long-term risk of secondary malignancies increases—among them, therapy-related hematologic malignancies. Therapy-related myeloid neoplasms are part of this category. However, despite improved cancer survival, the incidence has not shown a significant upward trend.
Epidemiologically, overall acute leukemia incidence is around 3–4 per 100,000, and therapy-related acute myeloid leukemia (t-AML), a subtype of AML, accounts for only 5–10% of cases. Importantly, t-MN has not been classified as a separate entity based on uniquely high-risk cytogenetic features.
Based on existing data, even as more patients live longer after cancer treatment, the overall incidence of t-MN remains relatively low.
A key feature of therapy-related hematologic malignancies is their distinct disease spectrum:
- Myeloid neoplasms (t-AML and therapy-related MDS) dominate
- Therapy-related ALL or therapy-related lymphoid malignancies are far less common
These patterns highlight the unique biology and clinical behavior of t-MN.
Q2
Patients with therapy-related neoplasms often respond poorly to conventional chemotherapy, and treatment is limited by cumulative toxicity and reduced performance status after prior anti-cancer therapy. Have any new strategies emerged that show benefit for these patients?
Professor Tang Feifei: Therapy-related acute leukemia is treated similarly to other AML subtypes—no special therapeutic regimen exists solely based on its therapy-related nature.
What differs is the patients’ physical condition: after previous cancer treatments, their tolerance to intensive chemotherapy is often reduced. Despite this, the fundamental therapeutic logic remains unchanged: treatment still relies on:
- chemotherapy
- and, where feasible, allogeneic hematopoietic stem cell transplantation (HSCT)
Outcomes are generally worse: treatment-related mortality is higher compared with de novo AML without prior therapy exposure. Nonetheless, treatment selection principles do not differ simply because of a therapy-related history.
Q3
Based on your center’s extensive experience, what are the main diagnostic and therapeutic bottlenecks in t-MN? Looking forward, what research directions are most likely to bring breakthroughs?
Professor Tang Feifei: Therapy-related AML is widely recognized to have poorer outcomes than de novo AML without prior chemotherapy or radiotherapy. Many studies support this view. However, current international classifications do not list t-AML as a standalone high-risk cytogenetic category.
This is because prognosis varies significantly by molecular subtype. Increasingly, t-AML risk assessment mirrors that of de novo AML: Specific genomic alterations determine risk, rather than the therapy-related origin alone.
For example:
- t-AML with NPM1 mutations
- or core-binding factor (CBF)-positive t-AML
may have relatively favorable outcomes, in contrast to most other t-AML subtypes.
Thus, future research must identify:
- which subgroups within t-AML have relatively good prognosis
- and which represent truly high-risk biology
A major practical challenge remains that t-AML patients tolerate chemotherapy poorly because of prior toxicities. This contributes to higher early mortality and possibly higher relapse rates.
However, not all t-AML cases carry uniformly poor prognosis—certain molecular subtypes remain exceptions. Current guidelines do not yet define “good-risk t-AML,” but accumulating genomic and clinical data will help establish more refined prognostic stratification systems, enabling individualized treatment.
Expert Profile
Professor Tang Feifei
Peking University People’s Hospital
- Chief Physician, Associate Professor, Master’s Supervisor
- Assistant to Chair, Department of Hematology
- Deputy Secretary-General, CACA Hematologic Oncology Committee
- Member, CACA Youth Council
- Deputy Leader, Young Scholars Group, Umbilical Cord Blood Committee
- Standing Member, Youth Committee, Hematology, China Medical Education Association
- Member, Leukemia Committee, China Medical Education Association
- Medical Appraisal Expert, Chinese Medical Association
- Board Member, Beijing Anti-Cancer Association
- Standing Member, Hematologic Malignancies Committee, Beijing Cancer Prevention Society
- Standing Member, Internal Medicine Committee, Beijing Women Physicians Association
- Medical Appraisal Expert, Beijing Medical Association
