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Bamahmud A, El-Sherbiny M, Jednak R, Muchantef K, Abish S, Mitchell D, Vezina C, Gupta IR. Case Report of Renal Calculi in a Child Receiving Imatinib for Acute Lymphoblastic Leukemia. Can J Kidney Health Dis 2023; 10:20543581231215849. [PMID: 38107158 PMCID: PMC10722952 DOI: 10.1177/20543581231215849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/12/2023] [Indexed: 12/19/2023] Open
Abstract
Rationale Imatinib is used in the treatment of Philadelphia chromosome positive (Ph+) leukemias and has been reported to have a direct effect on bone physiology. Presentation To report on a child with Ph+ acute lymphoblastic leukemia who presented with bilateral flank pain and gross hematuria. Diagnosis She was diagnosed with obstructive kidney stones 101 days after commencing daily oral imatinib. Stone analysis revealed the presence of calcium phosphate. Interventions and outcome The patient passed the stones spontaneously with medical therapy that included the use of thiazide, allopurinol, and potassium citrate, but she required temporary insertion of a double-J stent to relieve an obstruction. Novel findings Imatinib inhibits receptor tyrosine kinases and stimulates the flux of calcium from the extracellular fluid into bone, resulting in hypocalcemia with a compensatory rise in parathyroid hormone that may result in phosphaturia and the formation of calcium phosphate stones. Given that kidney stones are rare events in children, we believe that monitoring for kidney stone formation needs to be performed in children receiving imatinib.
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Affiliation(s)
- Alaa Bamahmud
- Department of Pediatrics, Division of Pediatric Nephrology, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada
| | - Mohamed El-Sherbiny
- Department of Pediatric Surgery, Division of Pediatric Urology, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada
| | - Roman Jednak
- Department of Pediatric Surgery, Division of Pediatric Urology, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada
| | - Karl Muchantef
- Department of Interventional Radiology, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada
| | - Sharon Abish
- Department of Pediatrics, Division of Hematology and Oncology, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada
| | - David Mitchell
- Department of Pediatrics, Division of Hematology and Oncology, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada
| | - Catherine Vezina
- Department of Pediatrics, Division of Hematology and Oncology, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada
| | - Indra R. Gupta
- Department of Pediatrics, Division of Pediatric Nephrology, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada
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Ramos-Casals M, Flores-Chávez A, Brito-Zerón P, Lambotte O, Mariette X. Immune-related adverse events of cancer immunotherapies targeting kinases. Pharmacol Ther 2022; 237:108250. [DOI: 10.1016/j.pharmthera.2022.108250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022]
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Johansson P, Kristjansdottir HL, Johansson H, Jakir A, Mellström D, Lewerin C. Highly increased risk of fracture in patients with myeloproliferative neoplasm. Leuk Lymphoma 2020; 62:211-217. [PMID: 32909485 DOI: 10.1080/10428194.2020.1817437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The risk for hip and vertebral fracture was determined in 10,752 patients diagnosed with myeloproliferative neoplasms (MPN) in Sweden 1995-2015. The mean follow-up time were 6.34 years. Five percent developed hip fracture and 1.3% a vertebral fracture. There was a significant increased risk for fracture among the MPN patients compared with the Swedish population. The ratio of observed (obs) and expected (exp) number of hip fracture in all MPN patients, polycythemia vera (PV), essential thrombocythemia and MPN undetermined (MPNu) was 1.20 (95% confidence interval (CI): 1.10-1.31), 1.37 (95% CI: 1.19-1.58), 1.02 (95% CI: 0.87-1.19), and 1.28 (95% CI: 1.07-1.52), respectively. Corresponding figures for vertebral fractures were 1.94 (95% CI: 1.64-2.29), 2.09 (95% CI: 1.56-2.75), 1.50 (95% CI: 1.06-2.07) and 2.47 (95% CI: 1.77-3.35), respectively. Patients with MPN had an increased risk of hip and vertebral fracture, especially patients with PV and MPNu in comparison with the entire Swedish population.
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Affiliation(s)
- Peter Johansson
- Section of Hematology and Coagulation, Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | - Helena Johansson
- Department of Public Health, McKillop Health Institute, Australian Catholic University, Melbourne, Australia.,Community of Medicine, University of Gothenburg Faculty of Health Sciences, Goteborg, Sweden
| | - Ana Jakir
- Section of Hematology and Coagulation, Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Dan Mellström
- Center of Bone and Arthritis Research, University of Gothenburg Faculty of Health Sciences, Goteborg, Sweden.,Department of Geriatric Medicine, University of Gothenburg Faculty of Health Sciences, Goteborg, Sweden
| | - Cataharina Lewerin
- Section of Hematology, Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
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Bedatsova L, Drake MT. The skeletal impact of cancer therapies. Br J Clin Pharmacol 2019; 85:1161-1168. [PMID: 30723928 DOI: 10.1111/bcp.13866] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/09/2018] [Accepted: 12/11/2018] [Indexed: 01/01/2023] Open
Abstract
Both cancer and therapies used in the treatment of cancer can have significant deleterious effects on the skeleton, increasing the risks for both bone loss and fracture development. While advancements in cancer therapies have resulted in enhanced cancer survivorship for patients with many types of malignancies, it is increasingly recognized that efforts to reduce bone loss and limit fractures must be considered for nearly all patients undergoing cancer therapy in order to diminish the anticipated future skeletal consequences. To date, most studies examining the impact of cancer therapies on skeletal outcomes have focused on endocrine-associated cancers of the breast and prostate, with more recent advances in our understanding of bone loss and fracture risk in other malignancies. Pharmacologic efforts to limit the adverse effects of cancer therapies on bone have nearly universally employed anti-resorptive approaches, although studies have frequently relied on surrogate outcomes such as changes in bone mineral density or bone turnover markers, rather than on fractures or other skeletal-related events, as primary study endpoints. Compounding current deficiencies for the provision of optimal care is the recognition that despite clearly written and straightforward society-based guidelines, vulnerable eligible patients are very often neither identified nor provided with appropriate treatments to limit the skeletal impact of their cancer therapies.
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Affiliation(s)
- Lucia Bedatsova
- Division of Endocrinology, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, 55905, USA
| | - Matthew T Drake
- Division of Endocrinology, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, 55905, USA
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Lotinun S, Suwanwela J, Poolthong S, Baron R. Kit W-sh Mutation Prevents Cancellous Bone Loss during Calcium Deprivation. Calcif Tissue Int 2018; 102:93-104. [PMID: 29032463 DOI: 10.1007/s00223-017-0334-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 09/25/2017] [Indexed: 12/25/2022]
Abstract
Calcium is essential for normal bone growth and development. Inadequate calcium intake increases the risk of osteoporosis and fractures. Kit ligand/c-Kit signaling plays an important role in regulating bone homeostasis. Mice with c-Kit mutations are osteopenic. The present study aimed to investigate whether impairment of or reduction in c-Kit signaling affects bone turnover during calcium deprivation. Three-week-old male WBB6F1/J-Kit W /Kit W-v /J (W/W v ) mice with c-Kit point mutation, Kit W-sh /HNihrJaeBsmJ (W sh /W sh ) mice with an inversion mutation in the regulatory elements upstream of the c-Kit promoter region, and their wild-type controls (WT) were fed either a normal (0.6% calcium) or a low calcium diet (0.02% calcium) for 3 weeks. μCT analysis indicated that both mutants fed normal calcium diet had significantly decreased cortical thickness and cancellous bone volume compared to WT. The low calcium diet resulted in a comparable reduction in cortical bone volume and cortical thickness in the W/W v and W sh /W sh mice, and their corresponding controls. As expected, the low calcium diet induced cancellous bone loss in the W/W v mice. In contrast, W sh /W sh cancellous bone did not respond to this diet. This c-Kit mutation prevented cancellous bone loss by antagonizing the low calcium diet-induced increase in osteoblast and osteoclast numbers in the W sh /W sh mice. Gene expression profiling showed that calcium deficiency increased Osx, Ocn, Alp, type I collagen, c-Fms, M-CSF, and RANKL/OPG mRNA expression in controls; however, the W sh mutation suppressed these effects. Our findings indicate that although calcium restriction increased bone turnover, leading to osteopenia, the decreased c-Kit expression levels in the W sh /W sh mice prevented the low calcium diet-induced increase in cancellous bone turnover and bone loss but not the cortical bone loss.
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Affiliation(s)
- Sutada Lotinun
- Department of Physiology and Craniofacial and Skeletal Disorders Research Group, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
- Division of Bone and Mineral Research, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.
| | - Jaijam Suwanwela
- Department of Prosthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Suchit Poolthong
- Department of Operative Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Roland Baron
- Division of Bone and Mineral Research, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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O’Sullivan S, Tay ML, Lin JM, Bava U, Callon K, Cornish J, Naot D, Grey A. Tyrosine Kinase Inhibitors Regulate OPG through Inhibition of PDGFRβ. PLoS One 2016; 11:e0164727. [PMID: 27737004 PMCID: PMC5063333 DOI: 10.1371/journal.pone.0164727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 09/29/2016] [Indexed: 01/01/2023] Open
Abstract
Nilotinib and imatinib are tyrosine kinase inhibitors (TKIs) used in the treatment of chronic myeloid leukemia (CML) and gastrointestinal stromal tumors (GIST). In vitro, imatinib and nilotinib inhibit osteoclastogenesis, and in patients they reduce levels of bone resorption. One of the mechanisms that might underlie these effects is an increase in the production of osteoprotegerin (OPG). In the current work we report that platelet-derived growth factor receptor beta (PDGFRβ) signaling regulates OPG production in vitro. In addition, we have shown that TKIs have effects on RANKL signaling through inhibition of the PDGFRβ and other target receptors. These findings have implications for our understanding of the mechanisms by which TKIs affect osteoclastogenesis, and the role of PDGFRβ signaling in regulating osteoclastogenesis. Further studies are indicated to confirm the clinical effects of PDGFRβ-inhibitors and to elaborate the intracellular pathways that underpin these effects.
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Affiliation(s)
- Susannah O’Sullivan
- Department of Pharmacology, University of Auckland, Auckland, New Zealand
- * E-mail:
| | - Mei Lin Tay
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Jian-Ming Lin
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Usha Bava
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Karen Callon
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Jillian Cornish
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Dorit Naot
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Andrew Grey
- Department of Medicine, University of Auckland, Auckland, New Zealand
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Tauer JT, Hofbauer LC, Jung R, Gerdes S, Glauche I, Erben RG, Suttorp M. Impact of long-term exposure to the tyrosine kinase inhibitor imatinib on the skeleton of growing rats. PLoS One 2015; 10:e0131192. [PMID: 26107505 PMCID: PMC4479438 DOI: 10.1371/journal.pone.0131192] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/30/2015] [Indexed: 11/19/2022] Open
Abstract
The tyrosine kinase (TK) inhibitor imatinib provides a highly effective therapy for chronic myeloid leukemia (CML) via inhibition of the oncogenic TK BCR-ABL1. However, off-target TKs like platelet-derived growth factor receptors (PDGF-R) and colony-stimulating factor-1 receptor (c-fms), involved in bone remodeling, are also inhibited. Thus, pediatric patients with CML on imatinib exhibit altered bone metabolism, leading to linear growth failure. As TKI treatment might be necessary for a lifetime, long-term effects exerted on bone in children are of major concern. Therefore, we studied the skeletal long-term effects of continuous and intermittent imatinib exposure in a juvenile rat model. Four-weeks-old male Wistar rats were chronically exposed to imatinib via drinking water over a period of 10 weeks. Animals were exposed to a standard and high imatinib dosage continuously and to the high imatinib dose intermittently. Bone mass and strength were assessed using pQCT, micro-computed tomography (μCT), and biomechanical testing at the prepubertal, pubertal, and postpubertal age. Bone length and vertebral height as well as biochemical markers of bone turnover were analyzed. Femoral and tibial bone length were dose-dependently reduced by up to 24% (p<0.0001), femoral and tibial trabecular bone mass density (BMD) were reduced by up to 25% (p<0.01), and femoral breaking strength was lowered by up to 20% (p<0.05). Intermittent exposure mitigated these skeletal effects. Long-term exposure resulted in reduced vertebral height by 15% and lower trabecular BMD by 5%. Skeletal changes were associated with suppressed serum osteocalcin (p<0.01) and non-significantly elevated serum CTX-I and PINP levels. In conclusion, imatinib mainly impaired longitudinal growth of long bones rather than the vertebrae of growing rats. Interestingly, intermittent imatinib exposure has less skeletal side effects, which may be beneficial in pediatric patients taking imatinib.
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Affiliation(s)
- Josephine T. Tauer
- Department of Pediatrics, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
- * E-mail:
| | - Lorenz C. Hofbauer
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Roland Jung
- Experimental Center of the Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Sebastian Gerdes
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ingmar Glauche
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Reinhold G. Erben
- Department of Biomedical Sciences, University of Veterinary Medicine, Vienna, Austria
| | - Meinolf Suttorp
- Department of Pediatrics, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
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Farmer S, Ocias LF, Vestergaard H, Broesby-Olsen S, Hermann AP, Frederiksen H. Bone morbidity in chronic myeloproliferative neoplasms. Expert Rev Hematol 2015; 8:447-56. [DOI: 10.1586/17474086.2015.1053456] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Breccia M, Molica M, Alimena G. How tyrosine kinase inhibitors impair metabolism and endocrine system function: A systematic updated review. Leuk Res 2014; 38:1392-8. [DOI: 10.1016/j.leukres.2014.09.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/23/2014] [Accepted: 09/27/2014] [Indexed: 01/24/2023]
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Farmer S, Horváth-Puhó E, Vestergaard H, Hermann AP, Frederiksen H. Chronic myeloproliferative neoplasms and risk of osteoporotic fractures; a nationwide population-based cohort study. Br J Haematol 2013; 163:603-10. [DOI: 10.1111/bjh.12581] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/16/2013] [Accepted: 08/21/2013] [Indexed: 01/22/2023]
Affiliation(s)
- Sarah Farmer
- Department of Haematology; Odense University Hospital; Odense Denmark
| | | | - Hanne Vestergaard
- Department of Haematology; Odense University Hospital; Odense Denmark
| | | | - Henrik Frederiksen
- Department of Haematology; Odense University Hospital; Odense Denmark
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
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Terpos E, Apperley J, Milojkovic D. Imatinib and chronic myeloid leukemia: close to the bone. Leuk Lymphoma 2013; 54:1581-2. [DOI: 10.3109/10428194.2013.772608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
CONTEXT The use of kinase inhibitors (KIs) in the treatment of cancer has become increasingly common, and practitioners must be familiar with endocrine-related side effects associated with these agents. This review provides an update to the clinician regarding the management of potential endocrinological effects of KIs. EVIDENCE ACQUISITION PubMed was employed to identify relevant manuscripts. A review of the literature was conducted, and data were summarized and incorporated. EVIDENCE SYNTHESIS KIs, including small molecule KIs and monoclonal antibodies directed against kinases, have emerged over the past decade as an important class of anticancer agents. KIs specifically interfere with signaling pathways that are dysregulated in certain types of cancers and also target common mechanisms of growth, invasion, metastasis, and angiogenesis. Currently, at least 20 KIs are approved as cancer therapeutics. However, KIs may affect a broad spectrum of targets and may have additional, unidentified mechanisms of action at the cellular level due to overlap between signaling pathways in the tumor cell and endocrine system. Recent reports in the literature have identified side effects associated with KIs, including alterations in thyroid function, bone metabolism, linear growth, gonadal function, fetal development, adrenal function, and glucose metabolism. CONCLUSIONS Clinicians need to monitor the thyroid functions of patients on KIs. In addition, bone density and vitamin D status should be assessed. Special care should be taken to follow linear growth and development in children taking these agents. Clinicians should counsel patients appropriately on the potential adverse effects of KIs on fetal development.
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Affiliation(s)
- Maya B Lodish
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the Pediatric Endocrinology Inter-Institute Training Program, National Institutes of Health, Bethesda, MD 20892, USA.
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O’Sullivan S, Horne A, Wattie D, Porteous F, Gamble G, Browett P, Grey A. Bone metabolism during long-term treatment with imatinib. Leuk Lymphoma 2013; 54:1783-5. [DOI: 10.3109/10428194.2012.760734] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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