Secondary Acute Myeloid Leukemia Following Niraparib Therapy in a Patient with BRCA2-Mutated Ovarian Cancer

Ovarian cancer is a leading cause of gynecologic cancer mortality, particularly in patients with high-grade serous carcinoma. Germline and somatic BRCA1/2 mutations strongly influence tumorigenesis and treatment response by enhancing platinum sensitivity and supporting the use of poly (ADP-ribose) polymerase (PARP) inhibitors. Niraparib has improved outcomes in BRCA-mutated, platinum-sensitive ovarian cancer; however, rare hematologic toxicities such as myelodysplastic syndrome and secondary acute myeloid leukemia (s-AML) may occur. We report s-AML that developed after 6 months of niraparib maintenance in a patient with BRCA2-mutated high-grade serous ovarian carcinoma. The patient achieved stable disease before presenting with pancytopenia that progressed to s-AML, resulting in death despite induction chemotherapy. Reported myelodysplastic syndrome/s-AML incidence with PARP inhibitors is approximately 1.4 percent, particularly in heavily pre-treated patients. Close hematologic surveillance is essential to detect these uncommon but life-threatening adverse events.