Metachronous Occurrence of Acute Myeloid Leukaemia in a Case of Neuroendocrine Tumour.

Abstract

Haematological neoplasms are rare in patients undergoing peptide receptor radionuclide therapy (PRRT) for neuroendocrine neoplasms, though the long-term effects on bone marrow function remain an area of interest. We report the case of an elderly woman diagnosed with a pancreatic neuroendocrine tumour (pNET) who developed acute myeloid leukaemia (AML) while receiving PRRT. She was treated with a non-chemotherapy regimen of azacitidine and venetoclax, resulting in remission of both AML and the neuroendocrine tumour. This case highlights the potential risk of secondary haematological malignancies following PRRT and underscores the efficacy of a non-intensive therapeutic approach in managing AML in this context.

Learning points: This case highlights the sequential use of peptide receptor radionuclide therapy (PRRT) with octreotide in managing a metastatic neuroendocrine tumour (NET) and its transition to a chemotherapy-free regimen for secondary acute myeloid leukaemia (AML). The integration of targeted radionuclide therapy with molecular oncology approaches is an evolving treatment paradigm that can modify future medical practice.The case underscores the challenge of detecting therapy-related myeloid neoplasms in patients undergoing PRRT. The delayed diagnosis of AML due to pancytopenia highlights the need for vigilant haematologic monitoring in patients receiving long-term PRRT and somatostatin analogue therapy.The successful management of both malignancies showcases the importance of multidisciplinary tumour boards in decision-making. It emphasises the role of internists in coordinating oncology care, recognising complications and implementing individualised treatment strategies to improve patient outcomes.