Due to simultaneous resistance to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI), pembrolizumab and granulocyte colony-stimulating factor (G-CSF) were administered, revealing prominent signs of hematological malignancy in a peripheral blood test that was later identified as t-APL.<h4>Conclusion</h4>In general, patients undergoing EGFR-TKI combined with local radiotherapy should be concerned about their hematological assessment. This evidence concerns the gene CSF3 and acute promyelocytic leukemia.