1
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Gartenberg A, Winkel M, Leonard N. Spontaneous tumor lysis syndrome in a patient with chronic myeloid leukemia treated successfully with allopurinol. Am J Emerg Med 2024; 78:242.e1-242.e3. [PMID: 38007380 DOI: 10.1016/j.ajem.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Tumor Lysis Syndrome (TLS) is an oncologic emergency that may occur in any patient with a hematologic malignancy, even prior to initiation of chemotherapy. Spontaneous TLS massive tumor cell destruction with intracellular electrolyte release prior to the initiation of chemotherapy. Spontaneous tumor lysis syndrome is a rare presentation, mainly occurring in Acute Leukemia and non-Hodgkin Lymphoma. Chronic Myeloid Leukemia (CML) is a low-risk disease based on TLS risk stratification. To the best of our knowledge, spontaneous TLS in the chronic phase of CML successfully treated with allopurinol and aggressive hydration has yet to be reported in the literature. A case report is described regarding a 67 year old Jamaican female with a history of hypertension who presented to the emergency department with abdominal pain, nausea, and vomiting for 1 day. The patient was found to have leukocytosis to 344,000 with 4% Blasts, hyperuricemia, and acute kidney injury. A peripheral blood smear confirmed the diagnosis of CML. Bone marrow biopsy was performed with evidence of the chronic phase of CML. The patient met clinical criteria for spontaneous tumor lysis syndrome. The patient was started on aggressive intravenous hydration, allopurinol, hydroxyurea and imatinib. Creatinine and uric acid level improved on this regimen within 48 h of initiation.
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Affiliation(s)
- Ariella Gartenberg
- Emergency Medicine, Jacobi Medical Center and Montefiore Medical Center, Bronx, NY, United States of America.
| | - Maia Winkel
- Emergency Medicine, Jacobi Medical Center and Montefiore Medical Center, Bronx, NY, United States of America
| | - Nicole Leonard
- Jacobi Medical Center and North Central Bronx Hospital, Bronx, NY, United States of America
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2
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Romero-Guerra AL, Salas-Cosio MDJ, Bautista-Martínez BA, Castillo-Rodríguez SA, Landa Juárez S, Hernández-Piñon Z, Saldaña Sánchez IDR, Núñez-Enríquez JC. Priapism and chronic myeloid leukemia in an adolescent. Rare debut presentation. A case report. ARCH ARGENT PEDIATR 2024; 122:e202310068. [PMID: 37871128 DOI: 10.5546/aap.2023-10068.eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Priapism is a painful and persistent erection, with or without sexual stimulation. A rare cause of such abnormality is chronic myeloid leukemia. Few cases of priapism as an initial manifestation of this type of leukemia have been reported in adolescent patients. Here we describe the case of a 16-year-old patient who presented with priapism as the initial manifestation of chronic myeloid leukemia. No cavernosal aspiration was performed. A specific hematological treatment was started and, given the persistence of priapism, the patient required 2 corpora cavernosa shunt procedures; despite this treatment, there is a high probability of sequelae.
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Affiliation(s)
- Ana L Romero-Guerra
- Department of Schoolchildren and Adolescents; Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Federal District, Mexico
| | - Miguel de J Salas-Cosio
- Department of Schoolchildren and Adolescents; Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Federal District, Mexico
| | - Benito A Bautista-Martínez
- Department of Pediatric Hematology; Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Federal District, Mexico
| | - Sebastián A Castillo-Rodríguez
- Department of Pediatric Imaging Studies; Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Federal District, Mexico
| | - Sergio Landa Juárez
- Department of Pediatric Urology; Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Federal District, Mexico
| | - Zayra Hernández-Piñon
- Department of Pediatric Hematology; Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Federal District, Mexico
| | - Iris Del R Saldaña Sánchez
- Department of Pediatric Urology; Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Federal District, Mexico
| | - Juan C Núñez-Enríquez
- Division of Research; Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Federal District, Mexico
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3
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Sutton KM, Wiggins M, Zaragoza R, Swamy S. Chronic spontaneous urticaria as the presenting feature in a paediatric case of chronic myeloid leukaemia. Pediatr Blood Cancer 2024; 71:e30846. [PMID: 38185755 DOI: 10.1002/pbc.30846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Kathryn M Sutton
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital (RNSH), Sydney, New South Wales, Australia
| | - Meredith Wiggins
- Department of Haematology, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Randwick, New South Wales, Australia
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Reina Zaragoza
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital (RNSH), Sydney, New South Wales, Australia
| | - Shruti Swamy
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital (RNSH), Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, University Sydney School of Medicine, Sydney, New South Wales, Australia
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4
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Tokatlı M, Ismayilov R, Çınar OE, Haznedaroğlu İC. Nilotinib-Associated Multiple Silent Arterial Stenoses in a Patient with Chronic Myeloid Leukemia. Turk J Haematol 2024; 41:59-60. [PMID: 38153228 PMCID: PMC10918391 DOI: 10.4274/tjh.galenos.2023.2023.0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/28/2023] [Indexed: 12/29/2023] Open
MESH Headings
- Humans
- Constriction, Pathologic/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Pyrimidines/adverse effects
- Leukemia, Myeloid/complications
- Protein Kinase Inhibitors/adverse effects
- Antineoplastic Agents/adverse effects
- Leukemia, Myeloid, Chronic-Phase/complications
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Affiliation(s)
- Mert Tokatlı
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Türkiye
| | - Rashad Ismayilov
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Türkiye
| | - Olgu Erkin Çınar
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Türkiye
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5
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Uchida Y, Koyama D, Manabe K, Suzuki K, Asano N, Endo M, Fukatsu M, Sano T, Hayashi K, Takano M, Takahashi H, Kimura S, Ikezoe T. High Efficacy and Safety of Asciminib in a Chronic Myeloid Leukemia Patient with Chronic Kidney Disease Following Renal Transplantation. Intern Med 2024; 63:717-720. [PMID: 37407456 PMCID: PMC10982009 DOI: 10.2169/internalmedicine.2179-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/29/2023] [Indexed: 07/07/2023] Open
Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm driven by the BCR::ABL1 tyrosine kinase. Tyrosine kinase inhibitors (TKIs) have been established as standard therapies for CML. However, some CML patients experience TKI intolerance. Asciminib was approved for CML patients either intolerant or refractory to TKI therapy. We herein report a 63-year-old CML patient who underwent renal transplantation and exhibited TKI intolerance. He was switched to asciminib, which achieved a deep molecular response without exacerbation of the renal function. Our experience revealed that asciminib is effective and safe for CML patients complicated with chronic kidney disease.
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Affiliation(s)
- Yasuhiro Uchida
- Department of Hematology, Fukushima Medical University, Japan
| | - Daisuke Koyama
- Department of Hematology, Fukushima Medical University, Japan
| | - Kazuya Manabe
- Department of Hematology, Fukushima Medical University, Japan
| | - Kengo Suzuki
- Department of Hematology, Fukushima Medical University, Japan
| | - Naomi Asano
- Department of Hematology, Fukushima Medical University, Japan
| | - Mamiko Endo
- Department of Hematology, Fukushima Medical University, Japan
| | | | - Takahiro Sano
- Department of Hematology, Fukushima Medical University, Japan
| | | | - Motoki Takano
- Department of Hematology, Fukushima Medical University, Japan
| | | | - Satoshi Kimura
- Department of Hematology, Fukushima Medical University, Japan
| | - Takayuki Ikezoe
- Department of Hematology, Fukushima Medical University, Japan
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6
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Tolou C, Bové M, Gualino O, Gualino V, Lajoie J, Maceri C. [Roth spots and perivascular infiltrates secondary to chronic myelocytic leukemia]. J Fr Ophtalmol 2024; 47:103916. [PMID: 37865536 DOI: 10.1016/j.jfo.2023.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 10/23/2023]
Affiliation(s)
- C Tolou
- Clinique Honoré-Cave, 406, boulevard Montauriol, 82000 Montauban, France.
| | - M Bové
- Clinique Honoré-Cave, 406, boulevard Montauriol, 82000 Montauban, France
| | - O Gualino
- Clinique Honoré-Cave, 406, boulevard Montauriol, 82000 Montauban, France
| | - V Gualino
- Clinique Honoré-Cave, 406, boulevard Montauriol, 82000 Montauban, France
| | - J Lajoie
- Clinique Honoré-Cave, 406, boulevard Montauriol, 82000 Montauban, France
| | - C Maceri
- Clinique Honoré-Cave, 406, boulevard Montauriol, 82000 Montauban, France
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7
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Huang CE, Lee KD, Chang JJ, Tzeng HE, Huang SH, Yu LHL, Chen MC. Association of Nilotinib With Cardiovascular Diseases in Patients With Chronic Myelogenous Leukemia: A National Population-Based Cohort Study. Oncologist 2024; 29:e81-e89. [PMID: 37561957 PMCID: PMC10769786 DOI: 10.1093/oncolo/oyad225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/12/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Tyrosine kinase inhibitor (TKI) treatment has been identified to be a risk factor for metabolic syndrome and cardiovascular diseases (CVDs) in patients diagnosed with chronic myeloid leukemia (CML). However, the specific contribution of post-TKI metabolic syndrome and the individual TKIs, including imatinib, nilotinib, and dasatinib, contribute to the development of CVDs remains unclear. METHODS We conducted a nationwide database to investigate the incidence of post-TKI metabolic syndrome, including diabetes, hyperlipidemia, and hypertension, as well as their association with CVDs. To compare the risk of post-TKI comorbidities and CVDs among TKIs, we utilized the incidence rate ratio (IRR), and subdistribution hazard ratio (SHR) calculated from multiple Fine-Gray models. RESULTS A total of 1211 patients without diabetes, 1235 patients without hyperlipidemia, and 1074 patients without hypertension were enrolled in the study. The incidence rate of post-TKI diabetes and hyperlipidemia was the highest in patients treated with nilotinib compared to imatinib and dasatinib (IRRs ≥ 3.15, Ps ≤ .047). After adjusting for confounders, nilotinib remained a significant risk factor for post-TKI diabetes and hyperlipidemia at an SHR of 3.83 (P < .001) and 5.15 (P < .001), respectively. Regarding the occurrence of CVDs, patients treated with nilotinib were more likely to develop CVDs than those treated with imatinib in non-hyperlipidemic group (IRR = 3.21, P = .020). Pre-existing and post-TKI hyperlipidemia were found to have a stronger association with CVDs, with SHR values of 5.81 (P = .034) and 13.21 (P = .001), respectively. CONCLUSION The findings of this study indicate that nilotinib treatment is associated with increased risks of diabetes and hyperlipidemia, with hyperlipidemia being the most significant risk for CVDs. Therefore, we recommend that CML patients receiving nilotinib should undergo screening for diabetes and hyperlipidemia prior to initiating TKI treatment. Additionally, regular monitoring of lipid profiles during TKI therapy and implementing effective management strategies to control hyperlipidemia are crucial.
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Affiliation(s)
- Cih-En Huang
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Der Lee
- Cell Therapy and Regenerative Medicine Center, Comprehensive Cancer Center, Taichung Veterans General Hospital, Taichung, Taiwan
- International Ph.D. Program for Cell Therapy and Regeneration Medicine, College of Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Jung-Jung Chang
- Division of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Huey-En Tzeng
- Division of Transfusion Medicine, Department of Pathology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Hao Huang
- Department of Public Health and Biostatistics Consulting Center, Chang Gung University, Taoyuan, Taiwan
| | | | - Min-Chi Chen
- Department of Public Health and Biostatistics Consulting Center, Chang Gung University, Taoyuan, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi, Taiwan
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8
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Shah K, Murugasamy S, Appaji L, Kumar A, Kumar N, Kaushik PS, Reddy M, Thumallapalli A, Aruna Kumari BS. Pediatric chronic myeloid leukemia P190 variant with IgA vasculitis: Rare association-case report. Pediatr Blood Cancer 2024; 71:e30755. [PMID: 37908041 DOI: 10.1002/pbc.30755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023]
MESH Headings
- Humans
- Child
- IgA Vasculitis/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Fusion Proteins, bcr-abl
- Leukemia, Myeloid
- Chronic Disease
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Affiliation(s)
- Krunal Shah
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Sathya Murugasamy
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Lingegowda Appaji
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Arun Kumar
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Nuthan Kumar
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Prakruthi S Kaushik
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Mohana Reddy
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Avinash Thumallapalli
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Bandagadde S Aruna Kumari
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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9
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Shi XY, Zhang JX, Tang ZX, Sun H, Shen Z. Severe spontaneous acute arterial subdural hematoma as an initial symptom of chronic myeloid leukemia. Br J Neurosurg 2023; 37:1721-1724. [PMID: 33605812 DOI: 10.1080/02688697.2021.1885625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
Acute subdural hematoma (SDH) is a rare occurrence in chronic myeloid leukemia (CML) patients with only two cases reported in literature. However, sudden severe acute SDH caused by CML has not been reported on. Our patient was admitted for 'sudden unconsciousness for more than 1 hour'. Computed tomography (CT) angiography revealed a large amount of acute SDH on the left side. Physical exam showed the patient's left pupil was dilated and signs of cerebral herniation were present. The preoperative coagulation profile was normal. Emergency craniotomy for hematoma clearance and decompression was performed. During the surgery, a ruptured cerebral artery was located in the perisylvian region and hemostasis was achieved through electrocautery. Pre-operative white blood count was 58,100 cell/µl, with post-operative bone marrow examination、cytogenetic analysis and RT-PCR detection revealing a diagnosis of CML, for which hydroxyurea chemotherapy was initiated. Leukocyte count of the patient gradually returned to normal. After 24 days, the patient regained consciousness and on day 30, repeat CT scan showed no SDH recurrence. The patient recovered with no neurological deficits and achieved a good prognosis.
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MESH Headings
- Humans
- Hematoma, Subdural, Acute/surgery
- Arteries
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Tomography, X-Ray Computed/adverse effects
- Computed Tomography Angiography
- Hematoma, Subdural, Chronic/diagnostic imaging
- Hematoma, Subdural, Chronic/etiology
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Affiliation(s)
- Xiao-Yong Shi
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Jin-Xia Zhang
- Department of Clinical Psychology(Sleep Medical Center), Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou 310000, Zhejiang Province, China
| | - Zhu-Xiao Tang
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Hu Sun
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Zheng Shen
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
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10
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Kaplan TM, Starr MR, Dalvin LA. Hyperviscosity retinopathy from chronic myelogenous leukemia. Can J Ophthalmol 2023; 58:e245-e246. [PMID: 37482077 PMCID: PMC10799180 DOI: 10.1016/j.jcjo.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Tyler M Kaplan
- Departments of Ophthalmology, Mayo Clinic, Rochester, MN
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11
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Iurlo A, Cattaneo D, Bucelli C, Spallarossa P, Passamonti F. Cardiovascular Adverse Events of Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia: Clinical Relevance, Impact on Outcome, Preventive Measures and Treatment Strategies. Curr Treat Options Oncol 2023; 24:1720-1738. [PMID: 38047977 DOI: 10.1007/s11864-023-01149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2023] [Indexed: 12/05/2023]
Abstract
OPINION STATEMENT The introduction of TKIs into the therapeutic armamentarium of CML has changed the disease paradigm, increasing long-term survival from 20% to over 80%, with a life expectancy now approaching that of the general population. Although highly effective, TKIs also have a toxicity profile that is often mild to moderate, but sometimes severe, with multiple kinases involved in the development of adverse events (AEs). Among others, cardiovascular AEs observed in TKI-treated CML patients may represent a significant cause of morbidity and mortality, and their pathogenesis is still only partially understood. In view of the recent introduction into daily clinical practice of new TKIs, namely the STAMP inhibitor asciminib, with a distinct safety profile, hematologists now more than ever have the opportunity to select the most suitable TKI for each patient, an aspect that will be fundamental in terms of personalized preventive and therapeutic strategies. Furthermore, physicians should be aware of the feasibility of TKI dose modifications at all stages of the patients' treatment journey, both at diagnosis for frail or elderly subjects or with multiple comorbidities, and during follow-up for those patients who experience toxicity, as well as to prevent it, with the main objective of reducing side effects while maintaining the response. Consequently, preserving the cardiovascular health of CML patients will likely be a more urgent topic in the near future, with specific measures aimed at controlling cardiovascular risk factors through a multidisciplinary approach involving a panel of healthcare professionals together with the hematologist.
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Affiliation(s)
- Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milano, Italy.
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milano, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Cristina Bucelli
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milano, Italy
| | - Paolo Spallarossa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino - Italian IRCCS Cardiology Network, Genova, Italy
| | - Francesco Passamonti
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milano, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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12
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Aghel N, Gustafson D, Delgado D, Atenafu EG, Fish JE, Lipton JH. High sensitivity c-reactive protein and circulating biomarkers of endothelial dysfunction in patients with chronic myeloid leukemia receiving tyrosine kinase inhibitors. Leuk Lymphoma 2023; 64:2008-2017. [PMID: 37554059 DOI: 10.1080/10428194.2023.2242990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/25/2023] [Accepted: 07/05/2023] [Indexed: 08/10/2023]
Abstract
Tyrosine kinase inhibitors (TKIs) have revolutionized the management of patients with chronic myelogenous leukemia (CML); however, they may cause cardiovascular (CV) toxicities. In this cross-sectional study, we explored whether high-sensitivity C-reactive protein (hsCRP) and novel markers of vascular dysfunction were associated with exposure to specific TKIs, in 262 CML patients. Hs-CRP level was not associated with CML disease activity or treatment with a specific TKI. Body mass index (OR: 1.15, 95% CI: 1.108-1.246; p < 0.001) and CML duration (OR: 1.004, 95% CI: 1.001-1.008; p = 0.024) were independently associated with higher hs-CRP. In exploratory analyses, novel endothelial-centric markers (e.g. ET-1 and VCAM-1) were differential across the various TKIs, particularly amongst nilotinib- and ponatinib-treated patients. While Levels of hs-CRP do not appear to be correlated with specific TKIs, circulating markers of vascular dysfunction were altered in patients treated with specific TKIs and should be explored as potential markers of TKI-associated CV risk.
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Affiliation(s)
- Nazanin Aghel
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Ted Rogers Program in Cardiotoxicity Prevention University Health Network, Toronto, Canada
- Division of Cardiology, Cardio-Oncology Program, McMaster University, Hamilton, Canada
| | - Dakota Gustafson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Diego Delgado
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Ted Rogers Program in Cardiotoxicity Prevention University Health Network, Toronto, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network University of Toronto, Toronto, ON, Canada
| | - Jason E Fish
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Ted Rogers Program in Cardiotoxicity Prevention University Health Network, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jeffrey H Lipton
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network University of Toronto, Toronto, ON, Canada
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13
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Han YD, Chen HJ. Chronic myeloid leukemia with sleep-related painful erections as a first symptom: a case report. J Med Case Rep 2023; 17:511. [PMID: 38031195 PMCID: PMC10688059 DOI: 10.1186/s13256-023-04222-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Sleep-related painful erections are characterized by deep penile pain that occurs during erections in the rapid eye movement stage of sleep. CASE PRESENTATION This case presents a 43-year-old Chinese Han patient with sleep-related painful erections. Turgid painful erections (4-5 episodes of tumescence) during the sleep hours caused pain. Further, blood testing revealed an abnormal increase in white blood cells (123 × 109/L). The patient was diagnosed with chronic myeloid leukemia by bone marrow biopsy, BCR::ABL1 fusion gene testing, and Philadelphia chromosome. However, the sleep-related painful erections have dramatically decreased in frequency of erectile pain after chemotherapy for Chronic myeloid leukemia in our case. CONCLUSION We considered that the occurrence of sleep-related painful erections was related to chronic myeloid leukemia and the case might be secondary sleep-related painful erections.
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MESH Headings
- Male
- Humans
- Adult
- Sleep
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Sleep, REM
- Chronic Disease
- REM Sleep Parasomnias/complications
- Pain
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Affiliation(s)
- Yao-Dong Han
- Department of Hematology, The First People's Hospital of Lanzhou, Lanzhou, 730050, China
| | - Hong-Jie Chen
- Department of Urology, The First People's Hospital of Lanzhou, Lanzhou, 730050, China.
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14
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Djerbi N, Zimmermann K, Roncador M, Becker MO, Manz MG, Balabanov S. Intrapatient competition of VEXAS syndrome and CML clones. Blood Adv 2023; 7:6815-6818. [PMID: 37738165 PMCID: PMC10679802 DOI: 10.1182/bloodadvances.2023010814] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/29/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023] Open
Affiliation(s)
- Nadia Djerbi
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Kathrin Zimmermann
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Marco Roncador
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Department of Biosystems Science and Engineering, Eidgenössische technische Hochschule Zurich, Basel, Switzerland
| | - Mike Oliver Becker
- Department of Rheumatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Markus G. Manz
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stefan Balabanov
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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15
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Ger M, Mandal S, Padhy SK, Sahu S. Unveiling the interplay: chronic myeloid leukaemia and diabetic proliferative retinopathy in a challenging case. BMJ Case Rep 2023; 16:e256534. [PMID: 37996142 PMCID: PMC10668127 DOI: 10.1136/bcr-2023-256534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Affiliation(s)
- Marina Ger
- Anant Bajaj Retina Institute, LV Prasad Eye Institute GMR Varalakshmi Campus, Visakhapatnam, India
| | - Sohini Mandal
- Dr Rajendra Prasad Centre For Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Srikanta Kumar Padhy
- Anant Bajaj Retina Institute, LV Prasad Eye Institute Bhubaneswar Campus, Bhubaneswar, Odisha, India
| | - Suman Sahu
- Anant Bajaj Retina Institute, LV Prasad Eye Institute Bhubaneswar Campus, Bhubaneswar, Odisha, India
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16
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Cheng F, Xiang H, Gale RP, Chen S, Qu J, Guo H, Li Q, Zhang Y, Li W. SARS-CoV-2 Omicron BA.5.2-infection and COVID-19 in persons with chronic myeloid leukaemia. J Cancer Res Clin Oncol 2023; 149:11025-11030. [PMID: 37337067 DOI: 10.1007/s00432-023-04995-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/15/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE A SARS-CoV-2 Omicron (BA.5.2) epidemic began in China in December, 2022 following stopping the zero COVID policy. METHODS We studied features of the epidemic in 1,121 persons with chronic myeloid leukaemia (CML). RESULTS 1103 (98%) were in chronic, 10 in accelerated and 8 in acute phases. 834 (74%) became infected almost all of whom met criteria for COVID-19. The most common symptoms were fever (91%), cough (90%) and fatigue (82%). 42 infected persons were asymptomatic. Most people quarantined at home and self-medicated. 22 were hospitalized for COVID-19. At admission 5 had mild, 14, moderate and 3, severe/critical disease according to World Health Organization (WHO) criteria. 5 received respiratory assistance, 3 were admitted to the intensive care unit (ICU) and 1 in accelerated phase died from COVID-19. Co-variates associated with a risk of COVID-19 in SARS-CoV-2-infected subjects include age ≥ 65 years, higher education level and imatinib therapy. CONCLUSION In conclusion, most SARS-CoV-2 Omicron BA.5.2 infections in persons with CML resulted in COVID-19 most of which cases are mild with only 1 death.
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Affiliation(s)
- Fang Cheng
- Department of Pharmacy, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan, 430022, China
| | - Hang Xiang
- Department of Hematology, The Ventral Hospital of Enshi Tujia and Miao Autonomous Prefecture, Yichang, 443000, China
| | - Robert Peter Gale
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College of Science, Technology and Medicine, London, UK
| | - Siyi Chen
- Department of Rheumatology and Immunology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jiao Qu
- Department of Hematology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hao Guo
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450000, Henan, China
| | - Qiubai Li
- Department of Rheumatology and Immunology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Hubei Engineering Research Center for Application of Extracellular Vesicles, Hubei University of Science and Technology, Xianning, China.
| | - Yanli Zhang
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450000, Henan, China.
| | - Weiming Li
- Department of Hematology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, 430022, China.
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17
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Balamurugan S, Kaur K, Gurnani B, Agrawal A. Bilateral acute vision loss as the initial presentation of chronic myeloid leukemia in a young female. Indian J Cancer 2023; 60:578-582. [PMID: 38206079 DOI: 10.4103/ijc.ijc_573_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 10/16/2021] [Indexed: 01/12/2024]
Abstract
Chronic myeloid leukemia (CML) is a hematological malignancy characterized by structural/functional changes and increased neutrophils. Rarely, ophthalmic manifestations are the first clue toward underlying pathology. We report a case of a 34-year-old woman who presented with sudden-onset diminution of vision in both eyes. On examination, she was diagnosed with panuveitis in the right eye and choroiditis in the left eye. Further investigations revealed an underlying CML in the accelerated phase. The patient was managed with systemic immunomodulators along with topical and periocular steroids. Prompt diagnosis and management in collaboration with an oncologist and hematologist helped us achieve a good outcome.
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Affiliation(s)
- Sivaraman Balamurugan
- Department of Uvea Services, Aravind Eye Hospital, Thavalakuppam, Cuddalore Main Road, Pondicherry, India
| | - Kirandeep Kaur
- Department of Pediatric Ophthalmology and Strabismus, Aravind Eye Hospital, Thavalakuppam, Cuddalore Main Road, Pondicherry, India
| | - Bharat Gurnani
- Department of Cornea and Refractive Services, Aravind Eye Hospital, Thavalakuppam, Cuddalore Main Road, Pondicherry, India
| | - Anushri Agrawal
- Department of General Ophthalmology, Aravind Eye Hospital, Thavalakuppam, Cuddalore Main Road, Pondicherry, India
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18
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Qi F, Bao M, Gao H, Zhang X, Zhao S, Wang C, Li W, Jiang Q. Patients with chronic myeloid leukemia and coronavirus disease 2019 in the Omicron era. Ann Hematol 2023; 102:2707-2716. [PMID: 37578540 DOI: 10.1007/s00277-023-05413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
To explore the prevalence and severity of COVID-19 and the mental health during the Omicron pandemic in patients with chronic myeloid leukemia (CML), a cross-sectional survey from 2609 respondents with CML was performed. A total of 1725 (66%) reported that they had COVID-19 during this period. Among them, 1621 (94%) were mild; 97 (6%), moderate; 7 (0.4%), severe; and 0, critical or death. Four hundred three (15%), 199 (8%), and 532 (20%) had moderate to severe depression, anxiety, and distress, respectively. Eight hundred ninety (34%), 667 (26%), and 573 (22%), avoidance, intrusion, and hyper-arousal, respectively. In multivariate analyses, longer TKI-therapy duration was significantly associated with a lower prevalence of COVID-19 (odds ratio [OR] = 0.98; 95% confidence interval [CI], 0.95, 0.99; p = 0.043); however, living in urban areas (OR = 1.6 [1.3, 2.0]; p < 0.001) and having family members with COVID-19 (OR = 18.6 [15.1, 22.8]; p < 0.001), a higher prevalence of COVID-19. Increasing age (OR = 1.2 [1.1, 1.4]; p = 0.009), comorbidity(ies) (OR = 1.7 [1.1, 2.7]; p = 0.010), and multi-TKI-resistant patients receiving 3rd-generation TKIs or investigational agents (OR = 2.2 [1.2, 4.2]; p = 0.010) were significantly associated with moderate or severe COVID-19. Female, comorbidity(ies), unvaccinated, and moderate or severe COVID-19 were significantly associated with almost all adverse mental health consequences; increasing age or forced TKI dose reduction because of various restriction during the pandemic, moderate to severe distress, avoidance, or intrusion; however, mild COVID-19, none or mild anxiety, distress, avoidance, or intrusion. In conclusion, shorter TKI-therapy duration, increasing age, comorbidity(ies), or multi-TKI-resistant patients receiving 3rd-generation TKIs or investigational agents had a higher prevalence of COVID-19 or higher risk of moderate or severe disease in patients with CML; increasing age, female, comorbidity(ies), forced TKI dose reduction due to the pandemic, moderate or severe COVID-19, unvaccinated, a higher likelihood of worse mental health.
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Affiliation(s)
- Feiyang Qi
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 Xizhimen South St, Beijing, 100044, China
| | - Mei Bao
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 Xizhimen South St, Beijing, 100044, China
| | - Hanlin Gao
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 Xizhimen South St, Beijing, 100044, China
| | - Xiaoshuai Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 Xizhimen South St, Beijing, 100044, China
| | - Shasha Zhao
- Peking University People's Hospital, Qingdao, China
| | | | - Wenwen Li
- Peking University People's Hospital, Qingdao, China
| | - Qian Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 Xizhimen South St, Beijing, 100044, China.
- Peking University People's Hospital, Qingdao, China.
- Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
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19
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Arai H, Yamamoto S, Matsubara T, Miyake T, Tochio A, Mii A, Shimizu A, Minamiguchi S, Muso E, Yanagita M. Focal Segmental Sclerosis Associated with the Novel Multi-tyrosine Kinase Inhibitor Ponatinib. Intern Med 2023; 62:2693-2698. [PMID: 36642524 PMCID: PMC10569927 DOI: 10.2169/internalmedicine.1283-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/07/2022] [Indexed: 01/15/2023] Open
Abstract
Ponatinib is a novel multi-tyrosine kinase inhibitor (TKI) with potent inhibitory activity against refractory chronic myeloid leukemia (CML). Despite its high clinical efficacy, ponatinib induces various adverse events due to its multi-target characteristic. However, renal complications associated with ponatinib are rare. A 76-year-old woman had a history of chronic myeloid leukemia (CML) resistant to imatinib and nilotinib. Our patient developed proteinuria and renal function deterioration during treatment with ponatinib but not with imatinib or nilotinib. We herein report the first case of a patient with secondary focal segmental glomerulosclerosis (FSGS) with partial glomerular collapse induced by ponatinib treatment.
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Affiliation(s)
- Hiroyuki Arai
- Department of Nephrology, Kyoto University Graduate School of Medicine, Japan
| | - Shinya Yamamoto
- Department of Nephrology, Kyoto University Graduate School of Medicine, Japan
| | - Takeshi Matsubara
- Department of Nephrology, Kyoto University Graduate School of Medicine, Japan
| | - Takafumi Miyake
- Department of Nephrology, Kyoto University Graduate School of Medicine, Japan
| | - Akira Tochio
- Department of Nephrology, Kyoto University Graduate School of Medicine, Japan
- Department of Nephrology, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Akiko Mii
- Department of Nephrology, Nippon Medical School, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Japan
| | | | - Eri Muso
- Division of Nephrology and Dialysis, Kitano Hospital, Japan
- Department of Food and Nutrition, Faculty of Contemporary Home Economics, Kyoto Kacho University, Japan
| | - Motoko Yanagita
- Department of Nephrology, Kyoto University Graduate School of Medicine, Japan
- Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Japan
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20
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Adegbite BO, Abramson MH, Gutgarts V, Musteata FM, Chauhan K, Muwonge AN, Meliambro KA, Salvatore SP, El Ghaity-Beckley S, Kremyanskaya M, Marcellino B, Mascarenhas JO, Campbell KN, Chan L, Coca SG, Berman EM, Jaimes EA, Azeloglu EU. Patient-Specific Pharmacokinetics and Dasatinib Nephrotoxicity. Clin J Am Soc Nephrol 2023; 18:1175-1185. [PMID: 37382967 PMCID: PMC10564352 DOI: 10.2215/cjn.0000000000000219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Dasatinib has been associated with nephrotoxicity. We sought to examine the incidence of proteinuria on dasatinib and determine potential risk factors that may increase dasatinib-associated glomerular injury. METHODS We examined glomerular injury through urine albumin-creatinine ratio (UACR) in 82 patients with chronic myelogenous leukemia who were on tyrosine-kinase inhibitor therapy for at least 90 days. t tests were used to compare mean differences in UACR, while regression analysis was used to assess the effects of drug parameters on proteinuria development while on dasatinib. We assayed plasma dasatinib pharmacokinetics using tandem mass spectroscopy and further described a case study of a patient who experienced nephrotic-range proteinuria while on dasatinib. RESULTS Participants treated with dasatinib ( n =32) had significantly higher UACR levels (median 28.0 mg/g; interquartile range, 11.5-119.5) than participants treated with other tyrosine-kinase inhibitors ( n =50; median 15.0 mg/g; interquartile range, 8.0-35.0; P < 0.001). In total, 10% of dasatinib users exhibited severely increased albuminuria (UACR >300 mg/g) versus zero in other tyrosine-kinase inhibitors. Average steady-state concentrations of dasatinib were positively correlated with UACR ( ρ =0.54, P = 0.03) and duration of treatment ( P = 0.003). There were no associations with elevated BP or other confounding factors. In the case study, kidney biopsy revealed global glomerular damage with diffuse foot process effacement that recovered on termination of dasatinib treatment. CONCLUSIONS Exposure to dasatinib was associated with a significant chance of developing proteinuria compared with other similar tyrosine-kinase inhibitors. Dasatinib plasma concentration significantly correlated with higher risk of developing proteinuria while receiving dasatinib. PODCAST This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_09_08_CJN0000000000000219.mp3.
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Affiliation(s)
- Benjamin O. Adegbite
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Internal Medicine, Mount Sinai Morningside/West, New York, New York
| | - Matthew H. Abramson
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Victoria Gutgarts
- Renal Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Florin M. Musteata
- Department of Pharmaceutical Sciences, Albany College of Pharmacy & Health Sciences, Albany, New York
| | - Kinsuk Chauhan
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alecia N. Muwonge
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kristin A. Meliambro
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Steven P. Salvatore
- Clinical Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
| | - Sebastian El Ghaity-Beckley
- Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marina Kremyanskaya
- Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bridget Marcellino
- Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John O. Mascarenhas
- Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kirk N. Campbell
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lili Chan
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Steven G. Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ellin M. Berman
- Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Edgar A. Jaimes
- Renal Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Evren U. Azeloglu
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
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21
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Ćojbašić I, Golubović I, Ćojbašić Ž. Clinical Outcomes of Patients with Chronic Myeloid Leukemia and COVID-19 Infection-A Single Center Survey. Medicina (Kaunas) 2023; 59:1564. [PMID: 37763683 PMCID: PMC10533142 DOI: 10.3390/medicina59091564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
Background: Previous research has shown different effects of hematological malignancies on the outcome of patients with COVID-19 infection depending on the type of disease and the treatment received. This research was aimed at examining the clinical outcome of COVID-19 infection in positive patients with chronic myeloid leukemia treated with tyrosine kinase inhibitors. Methods: We collected retrospective information on chronic myeloid leukemia patients who were treated and monitored in our institution during the pandemic period. Within this cohort, we recorded COVID-19 positive symptomatic patients and analyzed their basic characteristics, symptoms, severity, and outcome. Results: In the study cohort when COVID-19 was diagnosed, 86.7% of patients were on first-generation tyrosine kinase inhibitors therapy-imatinib. At the time of infection, 70% of patients were in molecular remission, 23.4% in complete cytogenetic remission, and 3.3% in complete hematological response. Most patients had symptomatic disease. Within the analyzed group, 56.7% of patients had asymptomatic/mild COVID-19 infection, 23.3% of patients had moderate symptoms which did not require hospitalization, and 20% of patients had severe/critical symptoms that required admission to the intensive care unit. More than half of the patients interrupted treatment with tyrosine kinase inhibitors temporarily during COVID-19. There were no deaths due to COVID-19 infection. Conclusions: In compliance with other larger clinical studies, analysis of the clinical outcome of COVID-19 infection in patients with chronic myeloid leukemia on tyrosine kinase inhibitors therapy in this study showed that they do not have an increased risk for COVID-19 infection and that they have a mild course of the disease with recovery.
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Affiliation(s)
- Irena Ćojbašić
- Faculty of Medicine, University of Niš, Blvd. Zorana Đinđića 81, 18000 Niš, Serbia;
- Clinic of Hematology, Allergology and Clinical Immunology, University Clinical Centre Niš, Blvd. Zorana Đinđića 48, 18000 Niš, Serbia;
| | - Ivana Golubović
- Clinic of Hematology, Allergology and Clinical Immunology, University Clinical Centre Niš, Blvd. Zorana Đinđića 48, 18000 Niš, Serbia;
| | - Žarko Ćojbašić
- Faculty of Mechanical Engineering, University of Niš, Aleksandra Medvedeva 14, 18000 Niš, Serbia
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22
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Aleem A, Alotaibi G, Iqbal Z, AlFaifi A. Eltrombopag for tyrosine kinase inhibitors-associated thrombocytopenia in chronic myeloid leukemia. Int J Hematol 2023; 118:288-291. [PMID: 36892804 DOI: 10.1007/s12185-023-03569-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 03/10/2023]
Abstract
Patients with newly diagnosed chronic-phase chronic myeloid leukemia (CP-CML) can develop cytopenias secondary to bone marrow hypoplasia after starting tyrosine kinase inhibitor (TKI) therapy. These adverse effects are usually transient, but cytopenias can persist in some patients. TKI-associated thrombocytopenia can develop in a significant proportion of CML patients and may require TKI dose reduction or dose interruptions. The thrombopoietin receptor agonist eltrombopag may improve thrombocytopenia in these patients, but the supporting literature for this approach is limited. Herein, we describe the case of a 56-year-old woman who developed persistent TKI-associated thrombocytopenia and intracranial hemorrhage. She could not tolerate full doses of imatinib and she failed to achieve a major molecular response (MMR). She responded to eltrombopag and platelet count improved, which allowed commencement and continuation of dasatinib as second-line TKI therapy, resulting in achievement of MMR. TKI-associated thrombocytopenia can cause serious bleeding and may also interfere with the management of CML by necessitating TKI dose interruption or reduction. Use of eltrombopag can help maintain adequate platelet counts and uninterrupted delivery of TKI therapy.
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Affiliation(s)
- Aamer Aleem
- Department of Medicine, Division of Hematology/Oncology (Oncology Center), College of Medicine and King Khalid University Hospital, King Saud University, P.O. Box 2378, Riyadh, 11472, Saudi Arabia.
| | - Ghazi Alotaibi
- Department of Medicine, Division of Hematology/Oncology (Oncology Center), College of Medicine and King Khalid University Hospital, King Saud University, P.O. Box 2378, Riyadh, 11472, Saudi Arabia
| | - Zafar Iqbal
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Al-Ahsa, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abrar AlFaifi
- Department of Medicine, Division of Hematology/Oncology (Oncology Center), College of Medicine and King Khalid University Hospital, King Saud University, P.O. Box 2378, Riyadh, 11472, Saudi Arabia
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23
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Harjianti T, Benyamin F, Minhajat R, Saleh S, Bayu D, Pababbari W. COVID-19 Infection in Chronic Myeloid Leukemia Patients Receiving Tyrosine Kinase Inhibitor in Makassar, Indonesia: A Six-Case Report and Literature Review. Acta Med Indones 2023; 55:332-338. [PMID: 37915153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Management of chronic myeloid leukemia (CML) in patients who are infected with COVID-19 is a challenging task due to disease-related or treatment-related factors that place such patients at a higher risk of complications. However, a low-infectivity-rate mechanism has been proposed by some researchers. In CML patients with COVID-19 infection, the most important treatment-related factor involves tyrosine kinase inhibitors (TKIs). In this case report, six patients with chronic-phase CML who experienced COVID-19 of mild-moderate severity all continued to receive TKI treatment for CML concurrently with COVID-19 treatment. All patients fully recovered. In the present study, we also review four other cases of COVID-19 infection in CML patients. Outcomes for TKI-treated CML patients who contract COVID-19 are influenced by many factors. Tyrosine kinase inhibitor therapy may benefit CML patients due to its antiviral effect, but the interaction between TKIs and drugs used for COVID-19 treatment requires careful monitoring. An individual approach is needed in every case.
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Affiliation(s)
- Tutik Harjianti
- Division of Medical Hemato-oncology, Department of Internal Medicine, Hasanuddin University - Wahidin Sudirohusodo Teaching Hospital, Makassar, Indonesia.
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McBride A, Brokars J, Reddy SR, Chang E, Tarbox MH, LeBlanc TW. An Analysis of Dasatinib Treatment Patterns in Patients with Chronic Myeloid Leukemia after Experiencing Pleural Effusion during Dasatinib Therapy. Acta Haematol 2023; 146:259-266. [PMID: 37037194 DOI: 10.1159/000530512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/27/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION Treatment with dasatinib for chronic myeloid leukemia (CML) has been associated with development of pleural effusion; however, data regarding its optimal management are limited. We examined treatment patterns and healthcare resource utilization (HCRU) and costs among patients with CML treated with dasatinib who experienced a subsequent pleural effusion. METHODS Adults with CML and ≥1 pharmacy claim for dasatinib in 2015-2018 who experienced pleural effusion after dasatinib were identified using data from claims databases. RESULTS Overall, 123 patients were eligible. After 1 year, of the 38.2% of patients with a dose modification, 72.3% did not switch treatment; among these patients, 70.6% continued treatment. Among patients with a stable dose after pleural effusion (61.8%), 57.9% later switched to another TKI. The mean (SD) duration of dasatinib treatment after pleural effusion was 262.0 (124.0) days for patients with a dose modification versus 149.1 (155.2) days for those with a stable dose (p < 0.001). HCRU and costs were similar between groups. CONCLUSION Dasatinib dose modification after pleural effusion was not always required; however, patients with dose modifications continued therapy for a longer duration with a lower rate of switching to another TKI versus patients who remained on a stable dose.
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Affiliation(s)
- Ali McBride
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - John Brokars
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Sheila Reiss Reddy
- PHAR (Partnership for Health Analytic Research), LLC, Beverly Hills, California, USA
| | - Eunice Chang
- PHAR (Partnership for Health Analytic Research), LLC, Beverly Hills, California, USA
| | - Marian H Tarbox
- PHAR (Partnership for Health Analytic Research), LLC, Beverly Hills, California, USA
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Futamura M, Ozaki Y, Makino H, Tsujimoto S, Shigesaka M, Tanaka A, Shimamoto K, Son Y, Ito T, Nomura S. Anti-MDA-5 Antibody-positive Dermatomyositis after Allogeneic Bone Marrow Transplantation for Acute Transformation of Chronic Myelogenous Leukemia. Intern Med 2023; 62:1081-1087. [PMID: 36070956 PMCID: PMC10125815 DOI: 10.2169/internalmedicine.9529-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Anti-melanoma differentiation-associated gene 5 (MDA-5) antibody-positive dermatomyositis is a disease with a poor prognosis associated with rapid progressive interstitial pneumonia. Autoimmune diseases have occasionally been reported to occur after hematopoietic stem cell transplantation (HSCT). We experienced a case of anti-MDA-5 antibody-positive dermatomyositis after HSCT. In this case, a sufficient dose of cyclophosphamide could not be administered due to an impaired bone marrow function. We discuss the complications of autoimmune diseases after HSCT.
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Affiliation(s)
- Mariko Futamura
- Department of Rheumatology and Clinical Immunology, Kansai Medical University Hospital, Japan
- First Department of Internal Medicine, Kansai Medical University, Japan
| | - Yoshio Ozaki
- Department of Rheumatology and Clinical Immunology, Kansai Medical University Hospital, Japan
- First Department of Internal Medicine, Kansai Medical University, Japan
| | - Hidehiko Makino
- Department of Rheumatology and Clinical Immunology, Kansai Medical University Hospital, Japan
- Department of Rheumatology, Osaka Medical and Pharmaceutical University Hospital, Japan
| | - Saki Tsujimoto
- Department of Rheumatology and Clinical Immunology, Kansai Medical University Hospital, Japan
- First Department of Internal Medicine, Kansai Medical University, Japan
| | - Minoru Shigesaka
- Department of Rheumatology and Clinical Immunology, Kansai Medical University Hospital, Japan
- First Department of Internal Medicine, Kansai Medical University, Japan
| | - Akihiro Tanaka
- Department of Rheumatology and Clinical Immunology, Kansai Medical University Hospital, Japan
- First Department of Internal Medicine, Kansai Medical University, Japan
| | - Keiko Shimamoto
- Department of Rheumatology and Clinical Immunology, Kansai Medical University Hospital, Japan
- First Department of Internal Medicine, Kansai Medical University, Japan
| | - Yonsu Son
- Department of Rheumatology and Clinical Immunology, Kansai Medical University Hospital, Japan
- First Department of Internal Medicine, Kansai Medical University, Japan
| | - Tomoki Ito
- First Department of Internal Medicine, Kansai Medical University, Japan
| | - Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Japan
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SahBandar IN, Sy CB, van den Akker T, Kim D, Geyer JT, Chadburn A, Cesarman E, Inghirami G, Allan JN, Siddiqui MT, Ouseph MM. Primary Effusion Lymphoma in an HIV-Negative Patient with Chronic Myeloid Leukemia Treated with Dasatinib. Pathobiology 2023; 90:356-364. [PMID: 36996787 PMCID: PMC10614567 DOI: 10.1159/000530429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/28/2023] [Indexed: 04/01/2023] Open
Abstract
INTRODUCTION Primary effusion lymphoma (PEL) is a malignant lymphomatous effusion, which by definition is Kaposi sarcoma herpesvirus/human herpesvirus 8-positive. PEL typically occurs in HIV-infected patients but can also occur in HIV-negative individuals, including in organ transplant recipients. Tyrosine kinase inhibitors (TKIs) are currently the standard of care for patients with chronic myeloid leukemia (CML), BCR::ABL1-positive. Although TKIs are extremely effective in treating CML, they alter T-cell function by inhibiting peripheral T-cell migration and altering T-cell trafficking and have been associated with the development of pleural effusions. CASE PRESENTATION We report a case of PEL in a young, relatively immunocompetent patient with no history of organ transplant receiving dasatinib for CML, BCR::ABL1-positive. DISCUSSION We hypothesize that the loss of T-cell function secondary to TKI therapy (dasatinib) may have resulted in the unchecked cellular proliferation of Kaposi sarcoma herpesvirus (KSHV)-infected cells, leading to the emergence of a PEL. We recommend cytologic investigation and KSHV testing in patients being treated with dasatinib for CML who present with persistent or recurrent effusions.
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MESH Headings
- Humans
- Dasatinib/adverse effects
- Lymphoma, Primary Effusion/diagnosis
- Lymphoma, Primary Effusion/drug therapy
- Lymphoma, Primary Effusion/chemically induced
- Sarcoma, Kaposi/chemically induced
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/chemically induced
- Herpesvirus 8, Human
- HIV Infections/complications
- HIV Infections/drug therapy
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Affiliation(s)
- Ivo N SahBandar
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA,
| | - Chandler B Sy
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Tayler van den Akker
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - David Kim
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Julia T Geyer
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Ethel Cesarman
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Giorgio Inghirami
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - John N Allan
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Madhu M Ouseph
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
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Lapietra G, Limongi MZ, Buffolino S, Nanni M, Ballarò D, Martelli M, Mancini M. Late appearance of JAK2 mutated polycythaemia vera in a patient with typical chronic myeloid leukaemia on imatinib: Speculations about role of therapeutic pressure and of secondary genetic events. Leuk Res 2023; 126:107035. [PMID: 36773488 DOI: 10.1016/j.leukres.2023.107035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023]
Affiliation(s)
- Gianfranco Lapietra
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Maria Zaira Limongi
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Sonia Buffolino
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Mauro Nanni
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Daniele Ballarò
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Marco Mancini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.
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Singh AK, Kumar A, Agrawal N, Bhurani D, Ahmed R, Sharma M. Prevalence of Anemia among Chronic Myeloid Leukemia Patients Treated with Imatinib: A Evidence-based Meta-analysis. Curr Rev Clin Exp Pharmacol 2023; 18:148-157. [PMID: 35293301 DOI: 10.2174/2772432817666220315144253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Imatinib is one of the tyrosine kinase inhibitors used for the treatment of chronic myeloid leukemia (CML) patients. The exact association of imatinib with anemia in CML patients is still unclear. AIM The current study aimed to find the prevalence of anemia in chronic myeloid leukemia patients treated with imatinib. METHODS The relevant articles were searched in PubMed, Google scholar, and Clinical trials registries till 31st July, 2021. The quality of the articles was assessed using the Newcastle-Ottawa Scale. The prevalence rate with 95% CI was calculated using StatsDirect Statistical analysis software V.3. RESULTS A total of 18 studies containing 3537 patients were found relevant for the analysis. The pooled prevalence of anemia in CML was found to be 34% (95% CI: 23%-46%). However, the heterogeneity among studies was found to be high. CONCLUSION The monitoring of hemoglobin levels and identifying the cause of anemia are major concerns for the CML patients treated with Imatinib.
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Affiliation(s)
- Avinash Kumar Singh
- Department of Pharmaceutical Medicine (Division of Pharmacology), School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, India
- Department of Hemato-Oncology & BMT Unit, Rajiv Gandhi Cancer Institute, and Research Centre, Sector - 5, Rohini, Delhi-110085, India
| | - Anoop Kumar
- Department of Pharmacology & Clinical Research, Delhi Pharmaceutical Sciences and Research University (DPSRU), Mehrauli-Badarpur Road, Puspvihar Sector 3, New Delhi 110017, India
| | - Narendra Agrawal
- Department of Hemato-Oncology & BMT Unit, Rajiv Gandhi Cancer Institute, and Research Centre, Sector - 5, Rohini, Delhi-110085, India
| | - Dinesh Bhurani
- Department of Hemato-Oncology & BMT Unit, Rajiv Gandhi Cancer Institute, and Research Centre, Sector - 5, Rohini, Delhi-110085, India
| | - Rayaz Ahmed
- Department of Hemato-Oncology & BMT Unit, Rajiv Gandhi Cancer Institute, and Research Centre, Sector - 5, Rohini, Delhi-110085, India
| | - Manju Sharma
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, India
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Graf I, Herndlhofer S, Kundi M, Greiner G, Sperr M, Hadzijusufovic E, Valent P, Sperr WR. Incidence of symptomatic Covid-19 infections in patients with mastocytosis and chronic myeloid leukemia: A comparison with the general Austrian population. Eur J Haematol 2023; 110:67-76. [PMID: 36193973 PMCID: PMC9874474 DOI: 10.1111/ejh.13875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 04/23/2023]
Abstract
BACKGROUND The SARS-COV-2 (Covid-19) pandemic has impacted the management of patients with hematologic disorders. In some entities, an increased risk for Covid-19 infections was reported, whereas others including chronic myeloid leukemia (CML) had a lower mortality. We have analyzed the prevalence of Covid-19 infections in patients with mastocytosis during the Covid-19 pandemic in comparison to data from CML patients and the general Austrian population. MATERIALS AND METHODS The prevalence of infections and PCR-proven Covid-19 infections was analyzed in 92 patients with mastocytosis. As controls, we used 113 patients with CML and the expected prevalence of Covid-19 in the general Austrian population. RESULTS In 25% of the patients with mastocytosis (23/92) signs and symptoms of infection, including fever (n = 11), dry cough (n = 10), sore throat (n = 12), pneumonia (n = 1), and dyspnea (n = 3) were recorded. Two (8.7%) of these symptomatic patients had a PCR-proven Covid-19 infection. Thus, the prevalence of Covid-19 infections in mastocytosis was 2.2%. The number of comorbidities, subtype of mastocytosis, regular exercise, smoking habits, age, or duration of disease at the time of interview did not differ significantly between patients with and without Covid-19 infections. In the CML cohort, 23.9% (27/113) of patients reported signs and symptoms of infection (fever, n = 8; dry cough, n = 17; sore throat, n = 11; dyspnea, n = 5). Six (22.2%) of the symptomatic patients had a PCR-proven Covid-19 infection. The prevalence of Covid-19 in all CML patients was 5.3%. The observed number of Covid-19 infections neither in mastocytosis nor in CML patients differed significantly from the expected number of Covid-19 infections in the Austrian population. CONCLUSIONS Our data show no significant difference in the prevalence of Covid-19 infections among patients with mastocytosis, CML, and the general Austrian population and thus, in mastocytosis, the risk of a Covid-19 infection was not increased compared to the general population.
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Affiliation(s)
- Irene Graf
- Division of Hematology and Hemostaseology, Department of Internal Medicine IMedical University of ViennaViennaAustria
- Ludwig Boltzmann Institute of Hematology and OncologyMedical University of ViennaViennaAustria
| | - Susanne Herndlhofer
- Division of Hematology and Hemostaseology, Department of Internal Medicine IMedical University of ViennaViennaAustria
- Ludwig Boltzmann Institute of Hematology and OncologyMedical University of ViennaViennaAustria
| | - Michael Kundi
- Institute of Environmental HealthMedical University of ViennaViennaAustria
| | - Georg Greiner
- Ihr Labor, Medical Diagnostic LaboratoriesViennaAustria
| | - Martina Sperr
- Division of Hematology and Hemostaseology, Department of Internal Medicine IMedical University of ViennaViennaAustria
| | - Emir Hadzijusufovic
- Division of Hematology and Hemostaseology, Department of Internal Medicine IMedical University of ViennaViennaAustria
- Ludwig Boltzmann Institute of Hematology and OncologyMedical University of ViennaViennaAustria
| | - Peter Valent
- Division of Hematology and Hemostaseology, Department of Internal Medicine IMedical University of ViennaViennaAustria
- Ludwig Boltzmann Institute of Hematology and OncologyMedical University of ViennaViennaAustria
| | - Wolfgang R. Sperr
- Division of Hematology and Hemostaseology, Department of Internal Medicine IMedical University of ViennaViennaAustria
- Ludwig Boltzmann Institute of Hematology and OncologyMedical University of ViennaViennaAustria
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Wang N, Guo Y, Fan Y, Liu C. Hemophagocytic Lymphohistiocytosis Appearing During Blast Phase of Chronic Myeloid Leukemia. Clin Lab 2023; 69. [PMID: 36649523 DOI: 10.7754/clin.lab.2022.220352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening illness with rapid progression and high mortality and is associated with genetic defects or can be induced by malignancies or severe infections. Most of the hematological malignancy-related HLH reported was accompanied by lymphoid neoplasms. METHODS Here, we present an unusual case of HLH with co-existing blast phase of chronic myeloid leukemia (CML-BP). RESULTS A diagnosis of AML-M5 with most likely concomitant HLH was made based on the clinical features, morphology, flow cytometry immunophenotyping, and genetics. Moreover, clinical characteristics were more suggestive of myeloid blast phase CML than de novo AML with the positive p210 BCR-ABL1. However, disease-causing mutations of HLH were not available, the patient probably had secondary malignancy-associated HLH induced by an acute infection. CONCLUSIONS The case focuses on the contribution of bone marrow morphological examination in getting the first diagnostic clue of CML-BP concomitant with HLH.
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MESH Headings
- Humans
- Blast Crisis/diagnosis
- Lymphohistiocytosis, Hemophagocytic/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myeloid, Acute/diagnosis
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31
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Wolf EB, Li D, Fernandez AJ, Gardner LB, Rivera CE, Wysokinska EM, Shaikh ME, Tun HW, Roy V, Alhaj Moustafa M. Acquired Factor VII Deficiency Associated With Chronic Myeloid Leukemia Blast Crisis. J Investig Med High Impact Case Rep 2023; 11:23247096231209543. [PMID: 37919949 PMCID: PMC10624022 DOI: 10.1177/23247096231209543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/26/2023] [Accepted: 10/08/2023] [Indexed: 11/04/2023] Open
Abstract
Factor VII (FVII) is an important, vitamin K-dependent clotting factor. Acquired FVII deficiency is a rare entity that is associated with serious bleeding complications. We report a case of acquired FVII deficiency in a patient with recurrent chronic myeloid leukemia in blast crisis who developed bilateral retinal hemorrhages. The coagulopathy was corrected with the initiation of chemotherapy and subsequent reduction in peripheral blast count.
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Affiliation(s)
| | - David Li
- Mayo Clinic, Jacksonville, FL, USA
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To AQ, Ciurea SO, Kongtim P. Acquired Factor V Deficiency: A New Cause of Bleeding in Patients with Chronic Myeloid Leukemia and Extreme Leukocytosis. Acta Haematol 2022; 146:543-546. [PMID: 35500558 DOI: 10.1159/000524630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/22/2022] [Indexed: 11/19/2022]
Abstract
Bleeding complications in patients with myeloproliferative neoplasms are known to be related to acquired von Willebrand disease or platelet dysfunction. Here, we describe two very similar cases of chronic phase chronic myeloid leukemia with extreme leukocytosis (>500,000/mcL) and deep tissue bleeding after a minor trauma, who had increased PT and PTT, normal VWF antigen and activity. The patients were found to have acquired factor V deficiency. Factor V deficiency as a cause of bleeding in patients with uncontrolled chronic myeloid leukemia has not yet been reported. Bleeding resolved after correction of hyperleukocytosis, and FV level improved. We conclude that acquired FV deficiency is possible in patients with uncontrolled chronic myeloid leukemia and extreme leukocytosis.
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Affiliation(s)
- An Quoc To
- Division of Hematology/Oncology, Department of Medicine, University of California Irvine, Orange, California, USA
| | - Stefan O Ciurea
- Division of Hematology/Oncology, Department of Medicine, University of California Irvine, Orange, California, USA
| | - Piyanuch Kongtim
- Division of Hematology/Oncology, Department of Medicine, University of California Irvine, Orange, California, USA
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33
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Almater AI, Alhadlaq GS, Alromaih AZ. Unilateral Subhyaloid Hemorrhage as a Presenting Sign of Chronic Myeloid Leukemia. Am J Case Rep 2022; 23:e936266. [PMID: 35484832 PMCID: PMC9063587 DOI: 10.12659/ajcr.936266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/28/2022] [Accepted: 03/24/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chronic myelogenous leukemia (CML) is a malignant myeloproliferative neoplasm of pluripotent stem cell origin. Ophthalmic manifestation as an initial presentation in cases of CML is extremely rare. Frequently, ocular lesions in CML are asymptomatic. However, vitreous or foveal involvement can result in a symptomatic visual loss and earlier presentation. Here, we report a rare case of monocular vision loss due to subhyaloid hemorrhage in a case of CML. CASE REPORT A 19-year-old healthy woman presented to the Emergency Department with sudden painless decrease in vision in her left eye for 1 day. Fundus examination revealed multiple intraretinal hemorrhages with some white-centered hemorrhages in 4 quadrants in both eyes, and subhyaloid hemorrhage involving the fovea in the left eye. Complete blood count and peripheral blood smear were consistent with the diagnosis of chronic myeloid leukemia. After referral to the hematology service, the diagnosis was confirmed based on bone marrow aspiration and chromosomal analysis. The patient then received the appropriate management and continued to follow up with the hematology service. CONCLUSIONS This case report highlights the rarity of ocular involvement as an initial manifestation of chronic myeloid leukemia, and the importance of systemic work-up for the diagnosis of this entity. A multidisciplinary team approach involving ophthalmologists, hematologists, and oncologists is paramount for the diagnosis and management of CML.
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Takahashi T, Turcotte LM, Gordon PM, Johnson AD, Rubin N, Spector LG. Therapeutic Leukapheresis in Pediatric Leukemia: Utilization Trend and Early Outcomes in a US Nationwide Cohort. J Pediatr Hematol Oncol 2022; 44:47-53. [PMID: 33735152 PMCID: PMC8568727 DOI: 10.1097/mph.0000000000002140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/05/2021] [Indexed: 11/25/2022]
Abstract
Leukapheresis (LA) in pediatric leukemia is performed for leukostasis, a life-threatening emergency in the setting of extremely increased blast cell counts. The authors aimed to assess the epidemiology of pediatric leukemia who received LA. The authors reviewed US nationally representative admission records of patients less than 20 years of age in the Kids' Inpatient Database for the years 2000, 2003, 2006, 2009, 2012, and 2016. Incidence of new leukemia cases who underwent LA were calculated for the years 2009, 2012, and 2016. Cox and logistic regression analyses were performed to ascertain the risk factors for adverse outcomes. There were 526 admissions for pediatric patients with acute lymphoblastic leukemia (ALL) (n=328), acute myeloid leukemia (AML) (n=124), or chronic myeloid leukemia (CML) (n=74) who underwent LA over the study period. The incidence of leukemia cases that required LA was lower in 2016 than in 2009 or 2012 (1.4%, 2.2%, and 2.7%, respectively; P=0.001). In-hospital mortality was higher in AML than ALL (hzard ratio, 3.2; 95% confidence interval, 1.1-9.1). None with CML died during admission. This first population-based study of LA in pediatric leukemia showed a decreased utilization of LA over recent years. The higher inpatient mortality in AML, as compared with ALL or CML, warrant further investigations.
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MESH Headings
- Child
- Humans
- Leukapheresis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/therapy
- Leukostasis
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Retrospective Studies
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Affiliation(s)
- Takuto Takahashi
- Division of Pediatric Hematology/Oncology, University of Minnesota, Minneapolis, MN
| | - Lucie M. Turcotte
- Division of Pediatric Hematology/Oncology, University of Minnesota, Minneapolis, MN
| | - Peter M. Gordon
- Division of Pediatric Hematology/Oncology, University of Minnesota, Minneapolis, MN
| | - Andrew D. Johnson
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Nathan Rubin
- Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Logan G. Spector
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN
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35
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Santos FM, Ghelfond G, Seguro FS, Abdo ANR, Dalessandro T, Maciel FVR, Bassolli L, Rocha V, Bendit I. Impact of pregnancy on the outcomes of childbearing age women with chronic myeloid leukemia. Am J Hematol 2022; 97:E72-E74. [PMID: 34822180 DOI: 10.1002/ajh.26424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Fernanda Maria Santos
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Division of Hematology, Transfusion Medicine and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
| | - Giovanna Ghelfond
- Division of Hematology, Transfusion Medicine and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
| | - Fernanda Salles Seguro
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Division of Hematology, Transfusion Medicine and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
| | - Andre Neder R Abdo
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Division of Hematology, Transfusion Medicine and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
| | - Thales Dalessandro
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Division of Hematology, Transfusion Medicine and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
| | - Felipe Vieira R Maciel
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Division of Hematology, Transfusion Medicine and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
| | - Lucas Bassolli
- Division of Hematology, Transfusion Medicine and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
| | - Vanderson Rocha
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Division of Hematology, Transfusion Medicine and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Churchill Hospital, Oxford University, Oxford, UK
| | - Israel Bendit
- Division of Hematology, Transfusion Medicine and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
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Autore F, Sora’ F, Chiusolo P, Minnella G, Colangelo M, Rossi E, Sica S. Chronic Myeloid Leukemia in a Patient with Previous Idiopathic Thrombocytopenic Purpura: How to Manage Imatinib Together with Eltrombopag. Medicina (B Aires) 2021; 57:medicina57121326. [PMID: 34946271 PMCID: PMC8708281 DOI: 10.3390/medicina57121326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022] Open
Abstract
The occurrence of chronic myeloid leukemia (CML), or other myeloproliferative diseases, after the development of idiopathic thrombocytopenic purpura (ITP) is very rare in the current medical literature. Considering the advances in ITP management, and the wide use of new drugs for ITP and CML, we report an unusual case with this association. Our case report focused on a 64-year-old man with long-standing ITP treated with eltrombopag, who developed hyperleukocytosis during follow-up; after specific laboratory exams, it was diagnosed as CML and he began treatment with imatinib. The treatment with eltrombopag was balanced with imatinib to stabilize his platelet count. Data on bcr-abl and JAK2 transcripts were collected and revealed an optimal response with the achievement of negativization of both molecular signatures. We could demonstrate that treatment with imatinib and eltrombopag was well tolerated and allowed complete molecular remission of CML to be achieved, as well as of ITP.
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MESH Headings
- Benzoates
- Humans
- Hydrazines/therapeutic use
- Imatinib Mesylate/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Male
- Middle Aged
- Purpura, Thrombocytopenic, Idiopathic/diagnosis
- Purpura, Thrombocytopenic, Idiopathic/drug therapy
- Pyrazoles
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Affiliation(s)
- Francesco Autore
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (F.S.); (P.C.); (G.M.); (E.R.); (S.S.)
- Correspondence: ; Tel.: +39-06-30155300
| | - Federica Sora’
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (F.S.); (P.C.); (G.M.); (E.R.); (S.S.)
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (F.S.); (P.C.); (G.M.); (E.R.); (S.S.)
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Gessica Minnella
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (F.S.); (P.C.); (G.M.); (E.R.); (S.S.)
| | - Maria Colangelo
- UOC Genetica Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy;
| | - Elena Rossi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (F.S.); (P.C.); (G.M.); (E.R.); (S.S.)
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (F.S.); (P.C.); (G.M.); (E.R.); (S.S.)
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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D'Souza N, Somervaille TCP, Mowatt DJ. Chronic myeloid leukemia presenting as compartment syndrome with acute loss of upper limb function. Am J Emerg Med 2021; 49:273-275. [PMID: 34174777 DOI: 10.1016/j.ajem.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022] Open
Abstract
Hematological malignancies rarely present with spontaneous haematomas (Lakhotia et al., 2015 [1]). Although cutaneous and mucous membrane bleeds do occur in chronic myeloid leukemia (CML) due to quantitative or qualitative platelet abnormalities, deep soft tissue bleeds are rare (Lakhotia et al., 2015 [1]). We report the case of a 49 year old man presenting with an acute hematoma of the left biceps brachii causing compartment syndrome of his left upper limb leading to flaccid paralysis. He underwent surgical evacuation of the hematoma and investigations revealed that he had CML with leukemic infiltration in the biceps brachii.
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Affiliation(s)
- Natasha D'Souza
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Tim C P Somervaille
- Cancer Research UK Manchester Institute, The University of Manchester, Manchester, United Kingdom; Department of Haematology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - David J Mowatt
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, United Kingdom.
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38
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Zheng Y, Wen J, Li J. Pediatric Chronic Myeloid Leukemia Presenting With Extreme Thrombocytosis and Acute Upper Gastrointestinal Hemorrhage: A Case Report. J Pediatr Hematol Oncol 2021; 43:e1049-e1051. [PMID: 34054046 DOI: 10.1097/mph.0000000000002216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Yongzhi Zheng
- Fujian Provincial Key Laboratory on Hematology, Department of Pediatric Hematology
| | - Jingjing Wen
- Fujian Provincial Key Laboratory on Hematology, Fujian Institute of Hematology, Fujian Medical University Union Hospital, Fujian, PR China
| | - Jian Li
- Fujian Provincial Key Laboratory on Hematology, Department of Pediatric Hematology
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Marchese A, Agarwal A, Gupta V. Loss of the Figure 8 Appearance on OCT: A Useful Clue for Leukemic Retinopathy. Ophthalmol Retina 2021; 4:237. [PMID: 32151344 DOI: 10.1016/j.oret.2019.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Alessandro Marchese
- Postgraduate Institute of Medical Education and Research, Chandigarh, India; Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Aniruddha Agarwal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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40
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Cutini I, Gozzini A, Nozzoli C, Boncompagni R, Innocenti C, Fani A, Saccardi R. Toxoplasmosis-Associated Hemophagocytic Lymphohistiocytosis in Allogeneic Transplantation. J Clin Immunol 2021; 41:843-846. [PMID: 33515363 DOI: 10.1007/s10875-021-00979-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
MESH Headings
- Disease Management
- Disease Susceptibility
- Graft vs Host Disease/diagnosis
- Graft vs Host Disease/etiology
- Hematopoietic Stem Cell Transplantation/adverse effects
- Hematopoietic Stem Cell Transplantation/methods
- Humans
- Immunosuppression Therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology
- Lymphohistiocytosis, Hemophagocytic/diagnosis
- Lymphohistiocytosis, Hemophagocytic/etiology
- Lymphohistiocytosis, Hemophagocytic/therapy
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Toxoplasmosis/complications
- Toxoplasmosis/diagnosis
- Toxoplasmosis/etiology
- Transplantation, Homologous
- Treatment Outcome
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Affiliation(s)
- Ilaria Cutini
- Department of Cellular Therapies and Transfusion Medicine, Careggi University Hospital, Florence, Italy.
| | - Antonella Gozzini
- Department of Cellular Therapies and Transfusion Medicine, Careggi University Hospital, Florence, Italy
| | - Chiara Nozzoli
- Department of Cellular Therapies and Transfusion Medicine, Careggi University Hospital, Florence, Italy
| | - Riccardo Boncompagni
- Department of Cellular Therapies and Transfusion Medicine, Careggi University Hospital, Florence, Italy
| | - Chiara Innocenti
- Department of Cellular Therapies and Transfusion Medicine, Careggi University Hospital, Florence, Italy
| | - Arianna Fani
- Department of Haematology, Careggi University Hospital, Florence, Italy
| | - Riccardo Saccardi
- Department of Cellular Therapies and Transfusion Medicine, Careggi University Hospital, Florence, Italy
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41
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Meguri Y, Deguchi K, Kawano T, Hayashino K, Komura A, Shiraishi Y, Yoshida C, Nagotani S, Yamamoto K, Imajo K. [Aseptic meningitis as paraneoplastic syndrome related to chronic myeloid leukemia in chronic phase]. Rinsho Ketsueki 2021; 62:1593-1597. [PMID: 34866081 DOI: 10.11406/rinketsu.62.1593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Chronic myeloid leukemia (CML) is a clonal hemopoietic stem cell disorder characterized by reciprocal translocation between the long arms of chromosomes 9 and 22 that produces the fusion BCR-ABL1 gene. Major manifestations in CML patients are increased white cell count and splenomegaly. In this case, the patient presented with aseptic meningitis and showed symptoms, such as disorientation, double vision, and neurogenic bladder disorder. Pulse steroid and antibiotic treatment was ineffective for these symptoms; however, the combination therapy with these drugs and dasatinib was very effective. Moreover, our patient had myelopathy that could have been induced by dasatinib after the treatment was started. To our knowledge, this is the first report of meningitis of the paraneoplastic syndrome associated with CML.
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MESH Headings
- Dasatinib/therapeutic use
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Meningitis, Aseptic
- Paraneoplastic Syndromes
- Translocation, Genetic
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Affiliation(s)
| | | | | | | | - Aya Komura
- Department of Hematology, Okayama City Hospital
| | | | | | | | | | - Kenji Imajo
- Department of Hematology, Okayama City Hospital
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Mughal TI, Pemmaraju N, Psaila B, Radich J, Bose P, Lion T, Kiladjian JJ, Rampal R, Jain T, Verstovsek S, Yacoub A, Cortes JE, Mesa R, Saglio G, van Etten RA. Illuminating novel biological aspects and potential new therapeutic approaches for chronic myeloproliferative malignancies. Hematol Oncol 2020; 38:654-664. [PMID: 32592408 PMCID: PMC8895354 DOI: 10.1002/hon.2771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/20/2020] [Indexed: 01/18/2023]
Abstract
This review reflects the presentations and discussion at the 14th post-American Society of Hematology (ASH) International Workshop on Chronic Myeloproliferative Malignancies, which took place on the December 10 and 11, 2019, immediately after the 61st ASH Annual Meeting in Orlando, Florida. Rather than present a resume of the proceedings, we address some of the topical translational science research and clinically relevant topics in detail. We consider how recent studies using single-cell genomics and other molecular methods reveal novel aspects of hematopoiesis which in turn raise the possibility of new therapeutic approaches for patients with myeloproliferative neoplasms (MPNs). We discuss how alternative therapies could benefit patients with chronic myeloid leukemia who develop BCR-ABL1 mutant subclones following ABL1-tyrosine kinase inhibitor therapy. In MPNs, we focus on efforts beyond JAK-STAT and the merits of integrating activin receptor ligand traps, interferon-α, and allografting in the current treatment algorithm for patients with myelofibrosis.
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MESH Headings
- Anemia/diagnosis
- Anemia/etiology
- Anemia/therapy
- Biomarkers
- Biomarkers, Tumor
- Combined Modality Therapy/adverse effects
- Combined Modality Therapy/methods
- Disease Management
- Disease Susceptibility
- Drug Development
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Molecular Diagnostic Techniques
- Molecular Targeted Therapy
- Myeloproliferative Disorders/complications
- Myeloproliferative Disorders/diagnosis
- Myeloproliferative Disorders/etiology
- Myeloproliferative Disorders/therapy
- Prognosis
- Single-Cell Analysis/methods
- Translational Research, Biomedical
- Treatment Outcome
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Affiliation(s)
| | | | - Bethan Psaila
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Jerald Radich
- Frederick Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Thomas Lion
- Childrens Cancer Research Institute, Vienna, Austria
| | | | - Raajit Rampal
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Tania Jain
- Sidney Kimmel Cancer Center, John Hopkins Hospital, Baltimore, Maryland, USA
| | | | - Abdulraheem Yacoub
- Division of Hematologic Malignancies, University of Kansas, Kansas City, Kansas, USA
| | - Jorge E. Cortes
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
| | - Ruben Mesa
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, Texas, USA
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Taniguchi Y, Takahashi N, Miura M, Hirase C, Sueda S, Espinoza JL, Rai S, Nakayama S, Serizawa K, Kumode T, Watatani Y, Morita Y, Tanaka H, Matsumura I. The Impact of Hemodialysis and Liver Cirrhosis on the Plasma Concentrations of Tyrosine Kinase Inhibitors in a Patient with Chronic Myeloid Leukemia. Intern Med 2020; 59:2745-2749. [PMID: 32641651 PMCID: PMC7691019 DOI: 10.2169/internalmedicine.4871-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We recently treated a chronic myeloid leukemia (CML) patient with liver and renal dysfunction, who was undergoing hemodialysis (HD). He was treated with 50 mg dasatinib (DAS) once daily just before HD. The maximum plasma concentration of DAS was 227 ng/mL on a non-HD day and 46.9 ng/mL on a HD day. He was subsequently treated with 200 mg bosutinib (BOS) once daily. The plasma concentration of BOS changed from 74.5 ng/mL before HD to 58.8 ng/mL after HD. Our results indicate that close monitoring of the plasma tyrosine kinase inhibitor concentrations should be considered in CML patients with organ impairment.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Aniline Compounds/blood
- Aniline Compounds/therapeutic use
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Dasatinib/blood
- Dasatinib/therapeutic use
- Female
- Humans
- Japan
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/physiopathology
- Liver Cirrhosis/physiopathology
- Liver Cirrhosis/therapy
- Male
- Middle Aged
- Nitriles/blood
- Nitriles/therapeutic use
- Protein Kinase Inhibitors/blood
- Quinolines/blood
- Quinolines/therapeutic use
- Renal Dialysis
- Renal Insufficiency/physiopathology
- Renal Insufficiency/therapy
- Treatment Outcome
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Affiliation(s)
- Yasuhiro Taniguchi
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
| | - Naoto Takahashi
- Departments of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
| | - Masatomo Miura
- Department of Pharmacy, Akita University Hospital, Japan
| | - Chikara Hirase
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
| | - Sanae Sueda
- Department of Hematology, PL General Hospital, Japan
| | - Jorge Luis Espinoza
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
- Faculty of Medicine, UNIDES University, Nicaragua
| | - Shinya Rai
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
| | - Shoko Nakayama
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
| | - Kentaro Serizawa
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
| | - Takahiro Kumode
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
| | - Yosaku Watatani
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
| | - Yasuyoshi Morita
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
| | - Hirokazu Tanaka
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
| | - Itaru Matsumura
- Departments of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Japan
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Sun YL, Liu LL, He Y, Zhang JW, Wen RJ, Yuan Q, Wang X, Guo RM, Li XD, Long B. Late-onset severe hepatic sinusoidal obstruction syndrome in an allogeneic stem cell transplant recipient: A case report. Medicine (Baltimore) 2020; 99:e22927. [PMID: 33120849 PMCID: PMC7581065 DOI: 10.1097/md.0000000000022927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Hepatic sinusoidal obstruction syndrome (SOS) is a rare and potentially fatal complications after hematopoietic stem cell transplantation (HSCT). Most severe SOS result in multi-organ dysfunction and are associated with a high mortality rate (>80%). PATIENT CONCERNS A 31-year-old man was diagnosed with chronic myeloid leukemia blast crisis. He presented with severe thrombocytopenia on day 42 post-HSCT (on days +42), gradually developed with painful hepatomegaly, ascites, and weight gain. DIAGNOSES The abdominal computerized tomography showed hepatomegaly, hepatic congestion, periportal edema, narrow hepatic vein, and ascites suggestive of SOS/hepatic vein occlusion. According to the EBMT revised diagnostic criteria, the patient was diagnosed as late-onset severe SOS. INTERVENTIONS Comprehensive treatment including low molecular weight heparin was initiated. OUTCOMES The patient had good response with resolution of his hepatomegaly, increase of platelet, weight and transaminase loss after 4 weeks treatment. LESSONS In SOS patients with nonspecific clinical and biochemical findings, computerized tomography scans can be useful in differentiating SOS from other complications after HSCT. low molecular weight heparin is effective for the treatment of SOS.
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Affiliation(s)
| | | | | | | | | | - Qing Yuan
- Department of Blood Transfusion, The Third Affiliated Hospital, Sun Yat-sen University
| | - Xin Wang
- Xiancun Street Community Health Service Center of Tianhe District
| | - Ruo-mi Guo
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Rajabto W, Djianzonie JAC, Pratisthita LB, Shatri H. Priapismus as Leukostasis Manifestation in Chronic Myeloid Leukemia. Acta Med Indones 2020; 52:420-422. [PMID: 33377887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Chronic Myeloid Leukemia (CML) is a myeloproliferative disease characterized by the presence of Philadelphia chromosome or BCR-ABL oncogene fusion. Patients with CML commonly present in the chronic phase with chief complaint of abdominal pain or early satiety. Priapism as the first manifestation of CML is a rare phenomenon. Priapism as a consequence of leukostasis is a urological emergency that requires immediate intracavernosus therapy followed by systemic therapy. We report a 44-year-old male patient presenting with priapism as the first manifestation of CML.
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MESH Headings
- Adult
- Antineoplastic Agents/therapeutic use
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukostasis/etiology
- Leukostasis/physiopathology
- Male
- Priapism/etiology
- Priapism/therapy
- Treatment Outcome
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Affiliation(s)
- Wulyo Rajabto
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
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Abstract
INTRODUCTION Nilotinib is a selective inhibitor of the BCR-ABL tyrosine kinase receptor and is used in the management of chronic myelogenous leukemia (CML). Nilotinib therapy at high doses is associated with elevated serum bilirubin levels. If the serum bilirubin level exceeds 3 times the upper limit of normal, the recommendation is to either adjust nilotinib dosage or temporarily discontinue the treatment. However, it is unclear whether hyperbilirubinemia indicates obvious liver histology damage. PATIENT CONCERNS A 24-year-old man with confirmed CML was treated with nilotinib therapy and developed hyperbilirubinemia after the treatment. Although the first remission of the hyperbilirubinemia was achieved after dose adjustment, the hematological parameters deteriorated. Thus, we initiated an antineoplastic therapy (at the standard dose) until complete remission of the CML was achieved. The pathogenic mechanism of hyperbilirubinemia may be related to the inhibition of uridine diphosphate-glucuronosyltransferase (UGT1A1) activity. Liver histological analysis revealed no significant liver damage. In addition, the patient had no family history of hyperbilirubinemia and liver disease. DIAGNOSIS The patient was admitted to our hospital under the diagnosis of hyperbilirubinemia, and histopathology by liver biopsy showed no obvious damage. We also detected a UGT1A1 mutation [ex1 c.686C > A (p.Pro229Gln)] in the patient and his mother. INTERVENTIONS When the nilotinib dose was decreased to 300 mg daily, the total bilirubin (TBIL) level decreased to 30 to 50 μmol/L for 1 month. However, because the Bcr-Abl/Abl ratio did not correspond to the major molecular response (MMR; <0.1%), the nilotinib dose was readjusted to 400 mg daily. One week later, the TBIL and indirect bilirubin levels increased to 89 and 79 μmol/L, respectively. The levels of alanine transaminase and other liver functional indicators were normal. OUTCOMES A Naranjo Adverse Drug Reaction (ADR) Probability Scale score of 13 indicates that hyperbilirubinemia is attributed to ADR caused by nilotinib rather than by drug-induced liver injury. CONCLUSION Although reducing the nilotinib dose can alleviate the occurrence of hyperbilirubinemia, the effect of MMR is also reduced. Treatment of CML without dose adjustment or discontinuation of nilotinib therapy may be more advantageous.
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Zhu H, Yang B, Liu J, Wu W, Ling Y. Case Report of acute myeloid leukemia with "WT1, ATRX, CEBPA, CSMD1, IKZF1, and LRP1B mutation and translocation between chromosome 1 and 19" developing from Philadelphia-negative chronic myeloid leukemia after TKI therapy. Medicine (Baltimore) 2020; 99:e18888. [PMID: 32011516 PMCID: PMC7220085 DOI: 10.1097/md.0000000000018888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE The success of tyrosine kinase inhibitor (TKI) therapy has greatly prolonged the survival time of patients with chronic myeloid leukemia (CML), harboring the characteristic Philadelphia (Ph) chromosome. However, a fraction of patients, achieving complete cytogenetic response after TKI therapy, develop a myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) with additional clonal chromosomal abnormalities in Philadelphia-negative cells (CCA/Ph-). PATIENT CONCERNS A 56-year-old woman with AML, developing from Philadelphia-negative CML after TKI therapy. She showed 6 kinds of somatic variants-CEBPA, ATRX, WT1, CSMD1, IKZF1, and LRP1B mutation after diagnosed as AML. DIAGNOSIS The patient was diagnosed with chronic phase CML that developed to AML after achieving durable complete cytogenetic response (CCR) and major molecular response (MMR). INTERVENTIONS The patient was treated with TKI therapy at the period of CML. When diagnosed with AML, she received induction chemotherapy regimens, consolidation therapy, and allogeneic hematopoietic stem cell transplantation subsequently. OUTCOMES The patient has been CCR and MMR for nearly 4 years, and has achieved complete remission after intervention related to AML. She is now preparing for allogeneic hematopoietic stem cell transplantation. LESSONS These rare occurrences highlight the importance of exploring the relevant pathogenesis of AML developing from CML after TKI therapy. In addition to monitoring molecular changes in the course of CML, cytogenetic analysis, or next-generation sequencing of CML patients should be performed.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Chromosomes, Human, Pair 1
- Chromosomes, Human, Pair 19
- Cytogenetic Analysis
- Female
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/etiology
- Leukemia, Myeloid, Acute/genetics
- Middle Aged
- Mutation
- Protein Kinase Inhibitors/therapeutic use
- Translocation, Genetic
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Jim HSL, Hyland KA, Nelson AM, Pinilla-Ibarz J, Sweet K, Gielissen M, Bulls H, Hoogland AI, Jacobsen PB, Knoop H. Internet-assisted cognitive behavioral intervention for targeted therapy-related fatigue in chronic myeloid leukemia: Results from a pilot randomized trial. Cancer 2020; 126:174-180. [PMID: 31553815 PMCID: PMC6906223 DOI: 10.1002/cncr.32521] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/07/2019] [Accepted: 07/18/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Fatigue is a common and disabling side effect of targeted therapies such as tyrosine kinase inhibitors (TKIs) used to treat chronic myeloid leukemia (CML). The goal of the current study was to conduct a pilot randomized trial of the first cognitive behavioral intervention developed for fatigue due to targeted therapy. METHODS Patients with CML treated with a TKI who were reporting moderate to severe fatigue were recruited and randomized 2:1 to cognitive behavioral therapy for targeted therapy-related fatigue (CBT-TTF) delivered via FaceTime for the iPad or to a waitlist control (WLC) group. The outcomes were acceptability, feasibility, and preliminary efficacy for fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue; primary outcome) and quality of life (Functional Assessment of Cancer Therapy-General; secondary outcome). Participants were assessed before randomization and after treatment (ie, approximately 18 weeks later). RESULTS A total of 44 patients (mean age, 55 years; 48% female) were assigned to CBT-TTF (n = 29) or WLC (n = 15). The study participation rate was 59%. Among the patients assigned to CBT-TTF, 79% completed the intervention. Intent-to-treat analyses indicated that patients assigned to CBT-TTF demonstrated greater improvements in fatigue (d = 1.06; P < .001) and overall quality of life (d = 1.15; P = .005) than those assigned to WLC. More patients randomized to CBT-TTF than WLC demonstrated clinically significant improvements in fatigue (85% vs 29%) and quality of life (88% vs 54%; P values ≤ .016). CONCLUSIONS CBT-TTF displays preliminary efficacy in improving fatigue and quality of life among fatigued patients with CML treated with TKIs. The findings suggest that a larger randomized study is warranted.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Cognition
- Cognitive Behavioral Therapy
- Disease-Free Survival
- Fatigue/complications
- Fatigue/physiopathology
- Fatigue/therapy
- Female
- Humans
- Internet
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/physiopathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Male
- Middle Aged
- Pilot Projects
- Quality of Life
- Treatment Outcome
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Affiliation(s)
- Heather S. L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Kelly A. Hyland
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Ashley M. Nelson
- Department of Psychology, University of South Florida, Tampa, Florida
| | | | - Kendra Sweet
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida
| | - Marieke Gielissen
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Academy Het Dorp, Arnhem, the Netherlands
| | - Hailey Bulls
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Aasha I. Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Paul B. Jacobsen
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, Maryland
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
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Teive HAG, Germiniani FMB, Munhoz RP, Camargo CHF. Blepharospasm and periorbital edema after imatinib mesylate: improvement with botulinum toxin. Arq Neuropsiquiatr 2020; 78:58-59. [PMID: 32074181 DOI: 10.1590/0004-282x20190109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/03/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Hélio A G Teive
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Clínica Médica, Serviço de Neurologia, Setor de Distúrbios do Movimento, Curitiba PR, Brasil
- Universidade Federal do Paraná, Hospital de Clínicas, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Curitiba PR, Brasil
| | - Francisco M B Germiniani
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Clínica Médica, Serviço de Neurologia, Setor de Distúrbios do Movimento, Curitiba PR, Brasil
| | - Renato P Munhoz
- University of Toronto, Toronto Western Hospital, Gloria and Morton Shulman Movement Disorders Centre, Toronto,ON, Canada
| | - Carlos Henrique F Camargo
- Universidade Federal do Paraná, Hospital de Clínicas, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Curitiba PR, Brasil
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Rustamov MN, Huseynov GR, Ahmedov IS. [Priapism as first clinical manifestation of chronic myeloid leucosis]. Urologiia 2019:112-113. [PMID: 31808643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Blood disorders, in particular chronic myeloid leukemia (CML), are among the rare etiological factors of priapism. A clinical observation of ischemic priapism lasting 18 hours, which developed in patients with previously not diagnosed CML, is presented in the article. The CML was subsequently diagnosed based on the results of blood analyses and bone marrow aspiration. Treatment strategy consisted of immediate aspiration of blood from the cavernous bodies (19G) followed by the intracavernous injection of phenylephrine solution. After resolving priapism, CML therapy was carried out, which allowed to avoid a recurrence of priapism.
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Affiliation(s)
- M N Rustamov
- Institute of Uronephrology and Reproductive Health, FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Azerbaijan Medical University, Baku, Azerbaijan
| | - G R Huseynov
- Institute of Uronephrology and Reproductive Health, FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Azerbaijan Medical University, Baku, Azerbaijan
| | - I S Ahmedov
- Institute of Uronephrology and Reproductive Health, FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Azerbaijan Medical University, Baku, Azerbaijan
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