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Neutropenia, lymphopenia and thrombopenia: 5 case reports A retrospective analysis of 9 patients treated between 2014–2019 described 5 patients including 4 male and 1 female patients, of whom 3 patient aged between 13–38 years [ages of two patients at the time of ADR onset not clearly stated], who developed neutropenia, lymphopenia or thrombopenia during off label treatment with temozolomide and etoposide [VP-16] for osteosarcoma [outcomes not stated]. This report describes a female patient: The female patient was diagnosed with metastatic osteosarcoma stage IIB at the age of 9 years. Then, she received various medications and underwent surgeries. However, the disease relapsed twice with further metastases. Thus, she started receiving off label therapy with oral temozolomide 150 mg/m2 on days 1–5 and oral etoposide 50 mg/m2 on days 1–12 of each 28-day cycle at the age of 17 years. She had received 52 cycles of temozolomide and etoposide therapy. However, she developed grade 3 lymphopenia and grade 3 thrombopenia. Therapy with temozolomide and etoposide was continued. This report describes a 15-year-old boy: The boy was diagnosed with metastatic osteosarcoma stage IV at the age of 14 years. Then, he received various medications and underwent surgeries. However, the disease relapsed twice with further metastases. Thus, he started receiving off label therapy with oral temozolomide 150 mg/m2 on days 1–5 and oral etoposide 50 mg/m2 on days 1–12 of each 28-day cycle at the age of 15 years. He had received two cycles of temozolomide and etoposide therapy. However, he developed grade 3 neutropenia. Later, his disease progressed further and he died due to metastatic osteosarcoma. This report describes a male patient: The male patient was diagnosed with metastatic osteosarcoma stage IIA at the age of 14 years. Then, he received various medications and underwent surgeries. However, the disease relapsed twice with further metastases. Thus, he started receiving off label therapy with oral temozolomide 150 mg/m2 on days 1–5 and oral etoposide 50 mg/ m2 on days 1–12 of each 28-day cycle at the age of 17 years. He had received 23 cycles of temozolomide and etoposide therapy. However, he developed grade 3 neutropenia. At follow-up, no evidence of osteosarcoma was noted. This report describes a 38-year-old man: The man was diagnosed with metastatic osteosarcoma stage IIB at the age of 28 year. Then, he received various medications including radiation therapy and underwent surgeries. However, the disease relapsed twice with further metastases. Thus, he started receiving off label therapy with oral temozolomide 150 mg/m2 on days 1–5 and oral etoposide 50 mg/m2 on days 1–12 of each 28-day cycle at the age of 38 years. He had received 6 cycles of temozolomide and etoposide therapy. However, he developed grade 3 neutropenia. This report describes a 13-year-old boy: The boy was diagnosed with metastatic osteosarcoma stage IIA at the age of 9 year. Then, he received various medications including radiation therapy and underwent surgeri