Case Report: Identification of Acute Promyelocytic Leukemia During Osimertinib Resistance Followed by Granulocyte Colony-stimulating Factor and Pembrolizumab

Overview

Journal Front Oncol

Specialty Oncology

Date 2023 Jan 30

PMID 36713543

Authors

Huohuan Tian

Linhui Yang

Wang Hou

Yu Wu

Yang Dai

Jiang Yu

Dan Liu

Affiliations

Soon will be listed here.

Abstract

Background: The occurrence of acute promyelocytic leukemia (APL) during the management of lung cancer is rare and life-threatening. It was mainly reported to be secondary to chemoradiotherapy. A few studies reported an increased incidence of therapy-related acute promyelocytic leukemia (t-APL) after gefitinib became available.

Case Presentation: We reported a patient who developed thrombocytopenia after receiving oral osimertinib in combination with intensity-modulated radiotherapy (IMRT). For half a year, she had an unrecoverable low platelet count, which progressed to concomitant leukopenia and the transient appearance of orthochromatic normoblasts in the peripheral blood test, indicating a dormant myeloid disorder. Due to simultaneous resistance to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI), pembrolizumab and granulocyte colony-stimulating factor (G-CSF) were administered, revealing prominent signs of hematological malignancy in a peripheral blood test that was later identified as t-APL.

Conclusion: In general, patients undergoing EGFR-TKI combined with local radiotherapy should be concerned about their hematological assessment. If patients exhibit unrecoverable abnormalities in routine blood tests, a secondary nonsolid malignancy other than myelosuppression should be considered, and further lung cancer treatment should be discontinued.

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