Propranolol-induced pancytopenia complicated by myelosuppression during induction therapy in a girl with acute lymphoblastic leukemia

Abstract

Pancytopenia induced by a noncytotoxic drug is a rare adverse event, but it makes the evaluation of bone marrow test results difficult once it occurs in patients with hematological diseases or receiving chemotherapy. We report here a case of acute lymphoblastic leukemia (ALL) accompanied by propranolol-induced pancytopenia, which made it difficult for us to assess remission achievement. A two-year-old girl with Noonan syndrome was diagnosed as having B-cell precursor ALL. Hypertrophic cardiomyopathy was detected during the induction chemotherapy, and propranolol was started. Despite a temporal hematopoietic recovery at the end of the induction chemotherapy, pancytopenia reappeared and bone marrow aspiration showed hypocellularity without leukemic blasts. Rapid hematopoietic recovery was observed after the suspension of propranolol and complete remission was confirmed thereafter. It is important to suspect noncytotoxic drug-induced pancytopenia and stop the administration of the responsible agent when unexplainable bone marrow suppression continues.