Retreatment with PARPi following stem cell transplant in a patient with recurrent ovarian cancer and myelodysplastic syndrome

IF 1.3 Q3 OBSTETRICS & GYNECOLOGY
Shilpa Mokshagundam , Mrinal M. Patnaik , Luigi A. DeVitis , Simrit K. Warring , Megan E. Grudem , Matthew S. Block
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引用次数: 0

Abstract

Objective

As the use of poly(adenosine diphosphate–ribose) polymerase inhibitors (PARPi) increases in the management of advanced ovarian cancer, therapy-related myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) may be observed more frequently. Strategies for management of this unique condition are needed.

Methods

In this case report, we demonstrate the case of a patient with advanced ovarian cancer and a pathogenic BRCA1 mutation who developed MDS following 4 years of maintenance PARPi.

Results

Management of therapy-related MDS/AML is variable. In addition, subsequent oncologic treatments may be limited due to risk of MDS/AML recurrence with exposure to cytotoxic therapies and/or PARPi. Risk for MDS/AML recurrence can be monitored and predicted by evaluation for clonal hematopoiesis. This patient underwent autologous stem cell transplant. After subsequent disease recurrence, she underwent repeat germline testing which showed BRCA1 wildtype. In addition, no clonal hematopoietic clones were identified using a specialized institutional assay. For this reason and given previous durable response to PARPi, the patient was re-treated with a PARPi.

Conclusions

This case highlights the unique management of therapy-related MDS/AML and underscores the importance of multidisciplinary care in determining safety of subsequent cancer-directed therapies in this patient population.
复发性卵巢癌合并骨髓增生异常综合征患者干细胞移植后再用PARPi治疗1例
随着多磷酸腺苷核糖聚合酶抑制剂(PARPi)在晚期卵巢癌治疗中的使用增加,治疗相关性骨髓增生异常综合征(MDS)和急性髓系白血病(AML)可能会更频繁地观察到。需要对这种特殊情况进行管理的策略。方法在本病例报告中,我们展示了一例晚期卵巢癌和致病性BRCA1突变患者在维持PARPi 4年后发展为MDS的病例。结果治疗相关MDS/AML的管理是可变的。此外,由于暴露于细胞毒性治疗和/或PARPi的MDS/AML复发风险,后续的肿瘤治疗可能受到限制。MDS/AML复发的风险可以通过评估克隆造血功能来监测和预测。该患者接受了自体干细胞移植。在随后的疾病复发后,她进行了重复的种系检测,结果显示BRCA1野生型。此外,没有克隆造血克隆鉴定使用专门的机构化验。由于这个原因,并考虑到先前对PARPi的持久反应,患者再次接受PARPi治疗。该病例强调了治疗相关MDS/AML的独特管理,并强调了多学科护理在确定该患者群体后续癌症定向治疗安全性方面的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Gynecologic Oncology Reports
Gynecologic Oncology Reports OBSTETRICS & GYNECOLOGY-
CiteScore
2.00
自引率
0.00%
发文量
183
审稿时长
41 days
期刊介绍: Gynecologic Oncology Reports is an online-only, open access journal devoted to the rapid publication of narrative review articles, survey articles, case reports, case series, letters to the editor regarding previously published manuscripts and other short communications in the field of gynecologic oncology. The journal will consider papers that concern tumors of the female reproductive tract, with originality, quality, and clarity the chief criteria of acceptance.
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