2022 Volume 40 Issue 3 Pages 173-178
Therapy-related myeloid neoplasms (t-MN) following exposure to poly (ADP-ribose) polymerase inhibitors (PARPi) are relatively rare complications associated with poor prognosis. Here we report a case of therapy-related acute myeloid leukemia (t-AML) presenting prolonged bicytopenia without blasts or dysplasia in peripheral blood smear during PARPi maintenance therapy for ovarian cancer. A 61-year-old woman underwent interval cytoreductive surgery after 3 cycles of chemotherapy (carboplatin plus paclitaxel). Complete response was achieved following additional 6 cycles of adjuvant chemotherapy. At 3 years after surgery, relapse occurred in the liver and subcutaneous lower abdominal wall. After 4 cycles of chemotherapy (carboplatin plus paclitaxel), complete resection of subcutaneous lesion was achieved. She received 3 cycles of adjuvant chemotherapy followed by olaparib maintenance therapy. From the 4th month of maintenance therapy, prolonged anemia and thrombocytopenia were observed and she received transfusion several times. Although no blast or dysplastic cell was observed in the peripheral blood smear, the diagnosis of t-AML was confirmed by bone marrow examination. Since cytopenia during PARPi maintenance therapy is common, it is challenging to suspect t-MN. Our experience suggests prolonged cytopenia during PARPi therapy should prompt further investigations including bone marrow examination.
