Myelodysplastic neoplasm (syndrome)
Meaning of myelodysplastic neoplasm (syndrome): For the purposes of this Statement of Principles, myelodysplastic neoplasm (syndrome): (a) means a clonal haematopoietic stem cell neoplasm characterised by morphologic dysplasia ≥10% in at least one cell line of erythroid, granulocyte, or megakaryocyte lines; persistent cytopaenia; progressively ineffective haematopoiesis; and increased risk of acute myeloid leukaemia; and (b) includes: (i) morphologically defined myelodysplastic neoplasm including myelodysplastic neoplasm with low blasts; hypoplastic myelodysplastic neoplasm; and myelodysplastic neoplasm with increased blasts; and (ii) myelodysplastic neoplasms with defined genetic abnormalities including myelodysplastic neoplasm with low blasts and 5q deletion; myelodysplastic neoplasm with low blasts and SF3B1 mutation; myelodysplastic neoplasm with biallelic TP53 inactivation; and (c) excludes: (i) leukaemia including acute myeloid leukaemia; (ii) myeloproliferative neoplasms including chronic myeloid leukaemia, chronic neutrophilic leukaemia, chronic eosinophilic leukaemia, polycythaemia vera, essential thromobocythaemia, primary myelofibrosis, and juvenile myelomonocytic leukaemia; (iii) aplastic anaemia; and (iv) Myelodyspl
Reasonable Hypothesis (RH) — Statement of Principles No. 76 of 2024
At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting myelodysplastic neoplasm (syndrome) or death from myelodysplastic neoplasm (syndrome) with the circumstances of a person's relevant service:
- (1)smoking at least 10 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before clinical onset, and: (a) smoking commenced at least 5 years before clinical onset; and (b) where smoking has ceased, clinical onset has occurred within 15 years of cessation;
Note: one pack-year is defined in the Schedule 1 - Dictionary.
- (2)being treated with one of the following drugs: (a) a topoisomerase II inhibitor, including etoposide, and doxorubicin; or (b) an alkylating agent including cyclophosphamide, chlorambucil, mechlorethamine, melphalan, nitrosoureas, cisplatin, carboplatin; or (c) azathioprine; (d) 5-fluorouracil; (e) taxanes including paclitaxel, and docetaxel; (f) granulocyte colony stimulating factor; before clinical onset, where treatment commenced at least 6 months before clinical onset, and where the treatment has ceased, within 20 years of cessation;
- (3)having received a cumulative equivalent dose of at least 0.01 sievert of ionising radiation to the bone marrow at least 1 year before clinical onset;
Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.
- (4)undergoing ablative treatment with radioactive iodine for thyroid cancer between 6 months and 3 years before clinical onset;
- (5)undergoing treatment with radioactive phosphorus for polycythaemia vera before clinical onset, where the first exposure occurred at least one year before clinical onset;
- (6)being exposed to benzene: (a) for a cumulative total of at least 1,250 hours within a continuous period of ten years before clinical onset; and (b) where the first exposure in that period occurred at least five years before clinical onset;
Note: being exposed to benzene is defined in the Schedule 1 - Dictionary.
- (7)receiving greater than 5 ppm-years of cumulative exposure to benzene before clinical onset, where the first exposure occurred at least 5 years before clinical onset;
Note: ppm-years is defined in the Schedule 1 - Dictionary.
- (8)having acquired immunodeficiency syndrome before clinical onset;
- (9)being obese for at least 5 years within the 20 years before clinical onset;
Note: being obese is defined in the Schedule 1 - Dictionary.
- (10)having one of the following autoimmune diseases before clinical onset; (a) pernicious anaemia; (b) polymyalgia rheumatica; (c) rheumatoid arthritis; (d) systemic lupus erythematosus; or (e) Behcet's disease;
- (11)completing a course of therapy for malignant neoplasm before clinical onset, where the first exposure occurred at least 6 months before clinical onset, and where that therapy has ceased, clinical onset occurred within 20 years of cessation;
- (12)inability to obtain appropriate clinical management for myelodysplastic neoplasm (syndrome) before clinical worsening;
Aggravation-only factors: the factors in subsection 9(12) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.
Balance of Probabilities (BoP) — Statement of Principles No. 77 of 2024
7 factors
At least one of the following factors must exist before it can be said that, on the balance of probabilities, myelodysplastic neoplasm (syndrome) or death from myelodysplastic neoplasm (syndrome) is connected with the circumstances of a person's relevant service:
- (1)smoking at least 15 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before clinical onset, and: (a) smoking commenced at least 10 years before clinical onset; and (b) where smoking has ceased, clinical onset has occurred within 10 years of cessation;
Note: one pack-year is defined in the Schedule 1 - Dictionary.
- (2)being treated with one of the following drugs: (a) a topoisomerase II inhibitor, including etoposide, and doxorubicin; or (b) an alkylating agent including cyclophosphamide, chlorambucil, mechlorethamine, melphalan, nitrosoureas, cisplatin, carboplatin; or (c) taxanes including paclitaxel, and docetaxel; before clinical onset, where treatment commenced at least 6 months before clinical onset, and where the treatment has ceased, within 20 years of cessation;
- (3)having received a cumulative equivalent dose of at least 0.05 sievert of ionising radiation to the bone marrow at least 2 years before clinical onset;
Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.
- (4)being exposed to benzene: (a) for a cumulative total of at least 2,500 hours within a continuous period of ten years before clinical onset; and (b) where the first exposure in that period occurred at least ten years before clinical onset; (c) where the last exposure in that period occurred within the 30 years before clinical onset;
Note: being exposed to benzene is defined in the Schedule 1 - Dictionary.
- (5)receiving greater than 10 ppm-years of cumulative exposure to benzene before clinical onset and; (a) where the first exposure occurred at least 10 years before clinical onset and: (b) where the last exposure occurred within the 30 years before clinical onset;
Note: ppm-years is defined in the Schedule 1 - Dictionary.
- (6)completing a course of therapy for malignant neoplasm before clinical onset, where the first exposure occurred at least 6 months before clinical onset, and where that therapy has ceased, clinical onset occurred within 10 years of cessation;
- (7)inability to obtain appropriate clinical management for myelodysplastic neoplasm (syndrome) before clinical worsening;
Aggravation-only factors: the factors in subsection 9(7) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.
