Paclitaxel Induced MDS and AML: A Case Report andLiterature Review

Therapy related acute myelogenous leukemia (AML) and myelodysplastic syndromes (MDS) have been classically linked toalkylating agents and topoisomerase inhibitors. They constitute about 1% of all AMLs. There is less evidence on association oftaxanes (paclitaxel and docetaxel) with these myeloid neoplasms. We present a case of paclitaxel therapy related acute myelogenousleukemia after treatment of endometrial cancer with a regimen containing paclitaxel and carboplatin. A 63-year-old femaleunderwent surgery followed by a total of 6 cycles of chemotherapy with carboplatin and paclitaxel. Six months after last cycleof chemotherapy, she was diagnosed with myelodysplastic syndrome with refractory anemia and excess blasts. Six weeks later,she had worsening anemia and thrombocytopenia which prompted a bone marrow biopsy which revealed acute myelomonocyticleukemia. A thorough literature review revealed 12 other case reports where taxanes have been implicated in the development oftherapy related myeloid neoplasm. Based on the timeline of events in our patient, paclitaxel is the likely culprit in the pathogenesis ofthis myeloid neoplasm. This rare but significantly grave adverse effect should be kept in consideration when deciding on treatmentoptions for gynecological malignancies.