Environmental Chemical Agents and the Risk of Myelodysplastic Syndrome: A Systematic Review of the Literature

Myelodysplastic syndrome (MDS) corresponds to a heterogeneous group of myeloid neoplasms characterized by ineffective hematopoiesis, persistent cytopenias, and variable risk of progression to acute myeloid leukemia. Evidence accumulated over time indicates that its etiology is multifactorial, involving the interaction between aging of the hematopoietic system, individual susceptibility, and environmental and occupational factors. In this scenario, chronic exposure to environmental chemical agents has emerged as an important risk factor for the development of MDS, especially in agricultural, industrial, and urban contexts. This study aimed to analyze, through a systematic review of the literature, the association between exposure to environmental chemical agents and the risk of MDS, identifying the main agents involved, the most frequent contexts of exposure, and the influence of the type and duration of exposure. The review was conducted according to PRISMA guidelines, with searches in electronic health databases using controlled descriptors and free terms related to MSD, environmental and occupational exposure, and chemical agents. After removing duplicates, studies were selected by screening titles and abstracts, followed by full-text reading, with standardized extraction of methodological and clinical data. The results demonstrated a consistent association between increased risk of MDS and prolonged exposure to pesticides and agrochemicals, herbicides, benzene, organic solvents, industrial and urban pollutants, dioxins, and other substances with genotoxic potential. Agricultural and industrial contexts were most frequently associated with risk, particularly rural and industrial workers and populations residing in environmentally contaminated areas. The duration of exposure proved to be a determining factor, since chronic and cumulative exposures were more strongly associated with the development of the disease than occasional exposures. The literatu