Multistep pathogenesis of t-MNs. Patient-related factors, including age, type, and treatment of primary disease, in the presence of germ-line variants, together with acquired factors, such as CHIP and inflammation, may all contribute to lay the groundwork for the development of myeloid diseases.^40-47  The subsequent cytotoxic therapy may later induce further genetic changes, the selection of abnormal hematopoietic clones, and changes in the microenvironment, resulting in the onset of a t-MN. Professional illustration created with BioRender.com.