Pathological findings suggesting vascular endothelial damage in multiple organs in chronic myelogenous leukemia patients on long-term tyrosine kinase inhibitor therapy
- 1 October 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in International Journal of Hematology
- Vol. 112 (4), 584-591
- https://doi.org/10.1007/s12185-020-02913-x
Abstract
A 66-year-old man with hypertension was diagnosed with chronic myelogenous leukemia in 1996. Treatment was started with hydroxycarbamide and imatinib 400 mg in 1996 + 6, which was increased to 600 mg. Although he achieved a complete cytogenic response in 1996 + 9, he could not continue imatinib because of edema; the regimen was changed to nilotinib 800 mg in 1996 + 13. After he achieved a molecular response better than 4.5 in 1996 + 19, he was referred to our hospital. His urinalysis had shown urine protein since 1996 + 13, and his creatinine level increased in 1996 + 16. Renal biopsy, performed in 1996 + 20, revealed abdominal distention and massive ascites. After the nilotinib dosage was reduced to 400 mg, liver biopsy, also performed in 1996 + 20, revealed hypertrophy of renal small blood vessels and endothelial cells of the hepatic artery and loss of endothelial cells of the renal glomeruli, portal vein, and hepatic sinusoids. Both renal and liver biopsies revealed marked pathological vascular damage. The patient took oral imatinib for approximately 3.5 years and nilotinib for 11 years. Pathological findings indicated a tendency for thrombosis, which could induce vascular occlusive disease. Accumulation of cases, such as the present case, is needed to further analyze the pathophysiological processes.Keywords
This publication has 19 references indexed in Scilit:
- Efficacy and safety of tyrosine kinase inhibitors for newly diagnosed chronic-phase chronic myeloid leukemia over a 5-year period: results from the Japanese registry obtained by the New TARGET systemInternational Journal of Hematology, 2019
- Deeper molecular response is a predictive factor for treatment-free remission after imatinib discontinuation in patients with chronic phase chronic myeloid leukemia: the JALSG-STIM213 studyInternational Journal of Hematology, 2017
- Long-Term Outcomes of Imatinib Treatment for Chronic Myeloid LeukemiaNew England Journal of Medicine, 2017
- Long-Term Follow-Up of the French Stop Imatinib (STIM1) Study in Patients With Chronic Myeloid LeukemiaJournal of Clinical Oncology, 2017
- Discontinuation of TKI therapy and ‘functional’ cure for CMLBest Practice & Research Clinical Haematology, 2016
- Final 5-Year Study Results of DASISION: The Dasatinib Versus Imatinib Study in Treatment-Naïve Chronic Myeloid Leukemia Patients TrialJournal of Clinical Oncology, 2016
- Long-term benefits and risks of frontline nilotinib vs imatinib for chronic myeloid leukemia in chronic phase: 5-year update of the randomized ENESTnd trialLeukemia, 2016
- Impact of comorbidities on overall survival in patients with chronic myeloid leukemia: results of the randomized CML Study IVBlood, 2015
- Tyrosine kinase inhibitor therapy in chronic myeloid leukemia: update on key adverse eventsExpert Review of Hematology, 2015
- Off-target effects of BCR–ABL1 inhibitors and their potential long-term implications in patients with chronic myeloid leukemiaLeukemia & Lymphoma, 2012