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Pancytopenia in a Patient With Metastatic Well-Differentiated Neuroendocrine Tumor After Peptide Receptor Radionuclide Therapy

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Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
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Article Information

Corresponding Author: Satya Das, MD, MSCI, Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, 777 Preston Research Bldg, 2220 Pierce Ave, Nashville, TN 37232 (satya.das@vumc.org).

Published Online: April 29, 2021. doi:10.1001/jamaoncol.2021.0183

Conflict of Interest Disclosures: Dr Das reported being a previous member of the Ipsen Speakers’ Bureau outside the submitted work. Dr Berlin reported being on the data safety monitoring boards of AstraZeneca, Novocure, Pancreatic Cancer Action Network Investigational Drug Steering Committee, and National Cancer Institute; being on the advisory boards of AstraZeneca, QED, Bayer, EMD Serono, Ipsen, Rafael, Clovis, FivePrime, Seagen, LSK, and Eisai; and receiving clinical trial support to his institution from Novartis (Array), AbbVie, Immunomedics, Taiho, Genentech/Roche, Bayer, Lilly, Incyte, Five Prime Therapeutics, Loxo, EMD Serono, Boston Biomedical, PsiOxus, Macrogenics, Boston Biomedical, Symphogen, Pfizer, I-Mab, WuXi, Dragonfly, and the National Cancer Institute. Dr Savona reported receiving grants from Astex, Takeda, Incyte, and TG Therapeutics; personal fees from BMS, AbbVie, Geron, Karyopharm, Ryvu, Sierra Oncology, Taiho, and TG Therapeutics and Karyopharm equity outside the submitted work.

Additional Contributions: We thank the patient for granting permission to publish this information. Mary Ann Thompson Arildsen, MD, PhD (Vanderbilt University Medical Center), provided the bone marrow biopsy photomicrographs. She was not compensated for her contribution.

References
1.
Basu  S , Ranade  R , Thapa  P .  Metastatic neuroendocrine tumor with extensive bone marrow involvement at diagnosis.   World J Nucl Med. 2016;15(1):38-43.PubMedGoogle Scholar
2.
Ozkalemkas  F , Ali  R , Ozkocaman  V ,  et al.  The bone marrow aspirate and biopsy in the diagnosis of unsuspected nonhematologic malignancy.   BMC Cancer. 2005;5:144. doi:10.1186/1471-2407-5-144 PubMedGoogle ScholarCrossref
3.
Sonbol  MB , Halfdanarson  TR , Hilal  T .  Assessment of therapy-related myeloid neoplasms in patients with neuroendocrine tumors after peptide receptor radionuclide therapy.   JAMA Oncol. 2020;6(7):1086-1092. doi:10.1001/jamaoncol.2020.0078 PubMedGoogle ScholarCrossref
4.
Goncalves  I , Burbury  K , Michael  M ,  et al.  Characteristics and outcomes of therapy-related myeloid neoplasms after peptide receptor radionuclide/chemoradionuclide therapy (PRRT/PRCRT) for metastatic neuroendocrine neoplasia.   Eur J Nucl Med Mol Imaging. 2019;46(9):1902-1910. doi:10.1007/s00259-019-04389-2 PubMedGoogle ScholarCrossref
5.
Takahashi  K , Wang  F , Kantarjian  H ,  et al.  Preleukaemic clonal haemopoiesis and risk of therapy-related myeloid neoplasms.   Lancet Oncol. 2017;18(1):100-111. doi:10.1016/S1470-2045(16)30626-X PubMedGoogle ScholarCrossref
6.
van der Zwan  WA , Brabander  T , Kam  BLR ,  et al.  Salvage peptide receptor radionuclide therapy with [177Lu-DOTA,Tyr3]octreotate in patients with bronchial and gastroenteropancreatic neuroendocrine tumours.   Eur J Nucl Med Mol Imaging. 2019;46(3):704-717. doi:10.1007/s00259-018-4158-1 PubMedGoogle ScholarCrossref
7.
Strosberg  J , El-Haddad  G , Wolin  E ,  et al; NETTER-1 Trial Investigators.  Phase 3 trial of 177Lu-Dotatate for midgut neuroendocrine tumors.   N Engl J Med. 2017;376(2):125-135. doi:10.1056/NEJMoa1607427 PubMedGoogle ScholarCrossref
8.
Brabander  T , van der Zwan  WA , Teunissen  JJM ,  et al.  Long-term efficacy, survival, and safety of [177Lu-DOTA0,Tyr3]octreotate in patients with gastroenteropancreatic and bronchial neuroendocrine tumors.   Clin Cancer Res. 2017;23(16):4617-4624. doi:10.1158/1078-0432.CCR-16-2743 PubMedGoogle ScholarCrossref
9.
Sabet  A , Ezziddin  K , Pape  UF ,  et al.  Long-term hematotoxicity after peptide receptor radionuclide therapy with 177Lu-octreotate.   J Nucl Med. 2013;54(11):1857-1861. doi:10.2967/jnumed.112.119347 PubMedGoogle ScholarCrossref
10.
Young  NS .  Aplastic anemia.   N Engl J Med. 2018;379(17):1643-1656. doi:10.1056/NEJMra1413485 PubMedGoogle ScholarCrossref
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