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JAMA Oncology Clinical Challenge
April 29, 2021

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

Author Affiliations
  • 1Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
JAMA Oncol. 2021;7(7):1060-1061. doi:10.1001/jamaoncol.2021.0183

A 72-year-old woman with metastatic, well-differentiated, small intestinal neuroendocrine tumor (NET) presented for routine follow-up in September 2020 with worsening fatigue and flushing. She was initially diagnosed with metastatic involvement of the liver, bone, and intra-abdominal lymph nodes in 2015 and received 3 treatments with peptide receptor radionuclide therapy (PRRT) in 2017. After 2 years of disease stability she was retreated with PRRT in November 2019 because of radiographic progression of disease and worsening symptoms. A third dose of PRRT was given in March 2020; a fourth was deferred owing to persistent thrombocytopenia after treatment. Gallium 68 dotatate positron emission tomography–computed tomography in July 2020 revealed stable disease (Figure, A).

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