{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T19:53:17Z","timestamp":1792007597470,"version":"4.4.0"},"reference-count":73,"publisher":"Bioscientifica","issue":"6","content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Peptide receptor radionuclide therapy (PRRT) with lutetium-177-Dotatate (177Lu-DOTATATE) has transformed neuroendocrine tumor (NET) treatment, improving progression-free survival, symptom control, and quality of life. However, long-term hematologic toxicities, including therapy-related myeloid neoplasms (tMN), are increasingly recognized. These rare but severe complications, such as myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML), appear multifactorial, influenced by prior cytotoxic therapies, radiation exposure, clonal hematopoiesis, and germline predispositions. This review synthesizes data on PRRT-related hematologic toxicities, including findings from pivotal studies and real-world evidence. We explore risk factors, underlying mechanisms, and the potential role of biomarkers, such as clonal hematopoiesis and germline mutations, in predicting toxicity. Emerging approaches, including alpha particle radioligand therapy and advanced dosimetry, are explored as strategies to optimize patient selection and minimize adverse outcomes. To maximize the benefits of PRRT while safeguarding patient safety, future efforts should focus on integrating predictive biomarkers, refining treatment sequencing, and developing personalized risk-stratified approaches to therapy.<\/jats:p>","DOI":"10.1530\/erc-25-0025","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T15:37:51Z","timestamp":1748619471000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-8","source":"Crossref","is-referenced-by-count":12,"title":["Therapy-related myeloid neoplasms in 177Lu-DOTATATE treated neuroendocrine tumor patients: how great is the risk?"],"prefix":"10.1530","volume":"32","author":[{"given":"Yael","family":"Kusne","sequence":"first","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Medicine, Mayo Clinic 1 , , ,","place":["Phoenix, Arizona, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mrinal M","family":"Patnaik","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Medicine, Mayo Clinic 2 , , ,","place":["Rochester, Minnesota, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8460-1257","authenticated-orcid":true,"given":"Thorvardur R","family":"Halfdanarson","sequence":"additional","affiliation":[{"name":"Department of Oncology, Mayo Clinic 3 , , ,","place":["Rochester, Minnesota, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6931-242X","authenticated-orcid":true,"given":"Mohamad Bassam","family":"Sonbol","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Medicine, Mayo Clinic 1 , , ,","place":["Phoenix, Arizona, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"key":"2026070905470244400_bib1","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1200\/JCO.2022.40.4_suppl.513","article-title":"Risk of myelodysplastic syndrome\/acute leukemia with sequential capecitabine\/temozolomide and 177Lu-dotatate","volume":"40","author":"Al-Toubah","year":"2022","journal-title":"J Clin Oncol"},{"key":"2026070905470244400_bib2","doi-asserted-by":"crossref","DOI":"10.1111\/jne.13138","article-title":"Real-world efficacy of lutetium peptide receptor radionuclide therapy in patients with neuroendocrine tumours","volume":"34","author":"Almeamar","year":"2022","journal-title":"J Neuroendocrinol"},{"key":"2026070905470244400_bib3","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1007\/s11899-022-00676-2","article-title":"Role of germline predisposition to therapy-related myeloid 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