HEC, as delivered in this trial, cannot be recommended in clinical practice because of the lack of superiority over classic CMF and because of the increased risk of AML observed in this arm. Prolongation of conventional anthracycline-based treatment beyond the current standard of four to six cycles is not recommended in clinical practice.

A 65-year-old female patient with glioblastoma multiforme (GBM) developed aplastic anemia following treatment with temozolomide. Following her diagnosis of GBM, the patient received standard treatment with surgery, concomitant radiation therapy and temozolomide followed by adjuvant temozolomide. On day 14 of her adjuvant treatment, she developed profound fatigue and spontaneous bruising and was noted to be severely pancytopenic. After an extensive workup, she was found to have aplastic anemia on bone marrow bipsy. Further studies did not reveal any other etiology and she was not on any other medications known to cause aplastic anemia. There have been two previously published cases involving aplastic anemia due to temozolomide. This case represents a rare but potentially fatal toxicity from temozolomide.

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