Recurrence after Long-Term Use of Poly ADP-Ribose Polymerase Inhibitors Triggered by Therapy-Related Myeloid Neoplasms - A Case Report

Sep 22, 2026

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Poly ADP-ribose polymerase (PARP) inhibitors are used as maintenance therapy for recurrent ovarian cancer, but long-term safety and the risk of therapy-related myeloid neoplasms remain concerns. A 49-year-old woman with stage IIIC high-grade serous ovarian carcinoma experienced multiple recurrences and long-term olaparib exposure with no notable adverse events initially. Five years later, she developed myelodysplastic syndrome progressing to acute myeloid leukemia, then developed abnormal genital bleeding and recurrent ovarian cancer with a rectovaginal fistula.

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CategoryHealthcare

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Case Reports in Oncology | Case Rep Oncol 2026;19:841–847 | | | --- | --- | | DOI: 10. 1159/000552167
Received: January 20, 2026
Accepted: April 13, 2026
Published online: April 28, 2026 | © 2026 The Author(s) .
Published by S. Karger AG, Basel [www.karger.com/cro](www.karger.com/cro) | This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ([https://karger.com/Services/OpenAccessLicense](https://karger.com/Services/OpenAccessLicense)). Usage and distribution for commercial purposes requires written permission. Case Report Recurrence after Long-Term Use of Poly ADP-Ribose Polymerase Inhibitors Triggered by Therapy-Related Myeloid Neoplasms: A Case Report Yurika Yamada a Akira Yokoia, b Hiroaki Kajiyamaa a Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan; b Nagoya University Institute for Advanced Research, Nagoya, Japan Keywords Ovarian cancer · Poly ADP-ribose polymerase inhibitors · Therapy-related myeloid neoplasms Abstract Introduction: Poly ADP-ribose polymerase (PARP) inhibitors are used as maintenance therapy for recurrent ovarian cancer, but their long-term safety, especially the risk of therapy-related myeloid neoplasms, remains a concern. Here, we report a case of disease recurrence and myeloid neoplasms following long-term treatment with PARP inhibitors. Case Presentation: A 49-yearold woman presented with stage IIIC (FIGO 2014), high-grade serous ovarian carcinoma. After initial surgery and chemotherapy, she achieved a complete response but experienced six recurrences between 2010 and 2017, each treated with chemotherapy. At the time of her sixth relapse, she received five cycles of nedaplatin and was subsequently administered olaparib. No notable adverse events occurred during olaparib treatment. Five years after starting olaparib treatment, she developed myelodysplastic syndrome, which progressed to acute myeloid leukemia after 2 months. Olaparib treatment was stopped following the diagnosis of myelodysplastic syndrome. She received eight cycles of venetoclax and azacitidine for approximately 1 year following her diagnosis of acute myeloid leukemia, but no hematologic response was achieved. Furthermore, she developed abnormal genital bleeding and recurrent ovarian cancer manifested as a rectovaginal fistula. Considering the seriousness of her condition, she was placed on best supportive care. She was eventually transferred to a hospice program, where she died from ovarian cancer and acute myeloid leukemia. Conclusions: While long-term PARP inhibitor therapy may prolong survival in ovarian cancer, this case highlights the risk of therapy-related myeloid neoplasms, particularly in heavily pretreated patients, and underscores the need for careful long-term monitoring and consideration of optimal maintenance duration. © 2026 The Author(s) . Published by S. KargerAG, Basel Correspondence to: Akira Yokoi, ayokoi [med.nagoya-u.ac.jp](med.nagoya-u.ac.jp) Case Reports in Oncology Case Rep Oncol 2026;19:841–847 842 | DOI: 10. 1159/000552167 | © 2026 The Author(s) . Published by S. Karger AG, Basel [www.karger.com/cro](www.karger.com/cro) | | --- | --- | Yamada et al.: Risks after Long-Term Treatment with PARP Inhibitors Introduction Ovarian cancer remains one of the most lethal gynecologic malignancies, primarily because of its high rate of recurrence and limited efficacy in the recurrent setting. Although the initial response to platinum-based chemotherapy is often favorable, the majority of patients experience relapse, and the prognosis for recurrent ovarian cancer is particularly poor [1] . Treatment of ovarian cancer with surgery and platinum-based chemotherapy has changed dramatically with the advent of poly ADP-ribose polymerase (PARP) inhibitors, particularly in patients with BRCA mutations or homologous recombination deficiency. In the SOLO2 trial, ol

FAQs

Why are PARP inhibitors used in recurrent ovarian cancer, and what risk is highlighted in this case report?

PARP inhibitors are used as maintenance therapy to prolong outcomes in recurrent ovarian cancer. The report emphasizes the long-term risk of therapy-related myeloid neoplasms, including MDS and AML.

What events occurred after the patient’s long-term olaparib treatment?

After several years on olaparib, she developed myelodysplastic syndrome that progressed to acute myeloid leukemia within two months. Olaparib was stopped after MDS diagnosis, followed by venetoclax and azacitidine without hematologic response.

How did the patient’s disease progress after stopping olaparib?

Beyond the myeloid disease progression, she later developed abnormal genital bleeding and recurrent ovarian cancer presenting as a rectovaginal fistula. She received best supportive care and was eventually transferred to hospice, where she died from ovarian cancer and acute myeloid leukemia.

Sep 22, 2026

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