JC EH lin xp ematopathol
Case Study
INTRODUCTIONChronic myelogenous leukemia (CML) is a chronic myeloproliferative neoplasm that originates from multipotent hematopoietic stem cells and is associated with the BCR-ABL fusion gene located on the Philadelphia (Ph) chromosome.1 Based on historical data prior to any effective therapy, median survival times for CML ranged between 2 and 3 years. 2 However, in the current era of tyrosine kinase inhibitor (TKI) therapy using imatinib, dasatinib, nilotinib, and bosutinib, the prognosis has been markedly improved. 3 Currently, an important issue is the management of adverse events. Pleural effusion is one of the major problems. The TKIs have different patterns of side effects, and pleural effusion is more frequently observed with dasatinib compared with imatinib, nilotinib, and bosutinib. [4][5][6][7] Primary effusion lymphoma (PEL) is a rare type of nonHodgkin lymphoma (NHL) confined to the body cavities, usually without a tumor mass.1 It is associated with infection of human herpesvirus 8 (HHV-8), and Epstein-Barr virus (EBV) coinfection is common, especially with a background of human immunodeficiency virus type-1 (HIV) infection. 8 However, some cases of HHV-8-negative primary lymphomatous effusion have been reported and termed HHV-8-unrelated PEL-like lymphoma. 9,10 In this report, we present a rare case of PEL-like lymphoma that was found during pleural effusion treatment with TKIs for CML.
CASE REPORTA 69-year-old Japanese male was hospitalized for cerebral infarction. Peripheral blood evaluation revealed a hemoglobin level of 12.2 g/dl, a platelet count of 98.6 x 10⁴ / μl, a white blood cell count of 26,800 /μl with 86% neutrophils, 6% lymphocytes, 1% monocytes, 1% eosinophils, 2% basophils, 2% myelocytes, and 2% metamyelocytes. Hepatitis B, Hepatitis C, HIV, and HTLV-1 were negative. Hypercellular bone marrow with an increase of megakaryocytes was observed on the bone marrow test, and the myeloblast count was less than 5% (Figure1). Chromosomal analysis was abnormal with 46, XY, t(9;22)(q34;q11.2) [20/20]. The patient was diagnosed with CML in the chronic phase. Dasatinib was started at 100 mg once daily. After a year of dasatinib treatment, the patient achieved major molecular response (MMR). However, he developed dyspnea and bilateral pleural effusion was observed on chest X-ray; therefore, diuretics were started. After two years on dasatinib, the patient achieved complete molecular response (CMR), but dasatinib treatment was discontinued due to exacerbation of Human herpesvirus 8-unrelated primary effusion lymphoma-like lymphoma following tyrosine kinase inhibitor treatment for chronic myelogenous leukemia A 69-year-old man was diagnosed with chronic myelogenous leukemia (CML) and treated with dasatinib. After two years on dasatinib, the patient achieved complete molecular response, but dasatinib treatment was discontinued due to exacerbation of pleural effusion. Nilotinib and imatinib were started but stopped due to an increase in pleural effusion. Thoracentes...