Hepatitis fulminante por imatinib en un paciente con leucemia mieloide crónica

Pascual, Cristina Martínez; Mas, M. Valdés; Moral, Jesús Miguel de la Peña; López, Manuel Miras

doi:10.1016/j.medcli.2010.09.011

Cited by 5 publications

(5 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[ 9 ] Side effects such as progressive decrease in platelet count in patients restrict the use of IM in standard dose. [ 10 , 11 ] In 2007, nilotinib was approved in the United States for the treatment of Philadelphia chromosome-positive CML, [ 5 ] which is resistant or intolerant to previous treatments, including imatinib, thus opening up the possibility of using new treatment strategies for patients with CML. [ 12 , 13 ]…”

Section: Discussionmentioning

confidence: 99%

Nilotinib-induced liver injury

Ya¹,

Ye²,

Zhou³

2020

Medicine

View full text Add to dashboard Cite

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 IS 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.

show abstract

Section: Discussionmentioning

confidence: 99%

Nilotinib-induced liver injury

Ya¹,

Ye²,

Zhou³

2020

Medicine

View full text Add to dashboard Cite

show abstract

“…Hepatic toxicity is usually resolved with either dosage reduction or discontinuation of imatinib [ 3 ], which has been permanently required in 0.5% of patients [ 6 ]. In this scenario, second-generation tyrosine kinase inhibitors such as dasatinib, nilotinib, sunitinib, and regorafenib may be used [ 2 , 8 , 9 , 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…[ 8 ] 2009 47 years, female CML 72 weeks LT Survived Martínez Pascual et al . [ 9 ] 2010 34 years, female CML 32 weeks LT Survived Harding et al . [ 2 ] 2016 30 years, female CML 20 weeks LT Survived Present case 2017 36 years, female CML 30 weeks LT Survived Abbreviations: CML chronic myeloid leukemia, PV Polycythemia vera, LT Liver transplant …”

Section: Discussionmentioning

confidence: 99%

“…Imatinib-induced ALF in a patient with CML was first described as being managed with dasatinib [ 2 ]. Even though severe hepatotoxicity may be observed in 1–4% of patients treated with imatinib, cases of fulminant liver failure are rare, with only eight known cases [ 2 – 9 ]. All cases but one involved patients with CML, and most of the cases were fatal [ 3 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…All cases but one involved patients with CML, and most of the cases were fatal [ 3 – 7 ]. LT was reported in four of them [ 2 , 5 , 8 , 9 ], with one postoperative death [ 5 ]. Nilotinib was used after LT in two cases [ 8 , 9 ], and Harding et al .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Imatinib-induced fulminant liver failure in chronic myeloid leukemia: role of liver transplant and second-generation tyrosine kinase inhibitors: a case report

et al. 2018

View full text Add to dashboard Cite

BackgroundThere is a worldwide problem of acute liver failure and mortality associated with remaining on the waiting for a liver transplant. In this study, we highlight results published in recent years by leading transplant centers in evaluating imatinib-induced acute liver failure in chronic myeloid leukemia and follow-up in liver transplantation.Case presentationA 36-year-old brown-skinned woman (mixed Brazilian race) diagnosed 1 year earlier with chronic myeloid leukemia was started after delivery of a baby and continued for 6 months with imatinib mesylate (selective inhibitor of Bcr-Abl tyrosine kinase), which induced liver failure. We conducted a literature review using the PubMed database for articles published through September 2017, and we demonstrate a role of liver transplant in this situation for imatinib-induced liver failure. We report previously published results and a successful liver transplant after acute liver failure due to imatinib-induced in chronic myeloid leukemia treatment.ConclusionsWe report a case of a successful liver transplant after acute liver failure resulting from imatinib-induced chronic myeloid leukemia treatment. The literature reveals the importance of prompt acute liver failure diagnosis and treatment with liver transplant in selected cases.

show abstract