Ovarian cancer is the second most common and the most lethal gynecological 
malignancy in the western world. Unfortunately, there are lack of methods for 
early screening and diagnosis of the disease. Because of this, most of the cases 
are diagnosed at an advanced stage and have poor prognosis. The standard 
treatment of ovarian cancer is maximal cytoreductive surgical debulking followed 
by platinum-based chemotherapy. There are new molecular agents available for 
maintenance therapy of ovarian cancer including anti-angiogenic therapies, poly 
adenosine diphosphate ribose polymerase inhibitors, inhibitors of growth factor 
signaling, or folate receptor inhibitors, as well as several immunotherapeutic 
approaches. Niraparib is a poly adenosine diphosphate ribose polymerase 
inhibitor that has shown to be clinically effective as maintenance therapy in 
patients with platinum sensitive, recurrent ovarian cancer. Studies have shown 
the median duration of progression-free survival was significantly longer among 
those receiving niraparib than among those receiving placebo, regardless of 
presence or absence of BRCA gene mutations or homologous recombination 
deficiency status. Studies have shown that treatment-emergent Grade 3 or Grade 4 
hematological events were observed in patients receiving niraparib including 
thrombocytopenia (33.8%), anemia (25.3%) and neutropenia (19.6%). Most of the 
hematological laboratory abnormalities occurred within the first three treatment 
cycles. After dose adjustment, the incidence of hematological abnormalities was 
infrequent beyond cycle 3. We are reporting two cases of Grade III/IV 
neutropenia and thrombocytopenia in patients treated with niraparib in our 
institution. Unfortunately, one of the patients succumbed to septic shock 
secondary to right lower lobe pneumonia while severely neutropenic. The second 
patient's blood counts improved after discontinuing the medication and with 
supportive transfusions during the hospitalization.