Possible association between Budd‐Chiari syndrome and gemtuzumab ozogamicin treatment in a patient with refractory acute myelogenous leukemia

Abstract

Gemtuzumab ozogamicin (GO; CMA‐676; Mylotarg™) is a chemotherapeutic agent approved for the treatment of CD33‐positive acute myelogenous leukemia in patients of age 60 years or older after first relapse. Hepatic veno‐occlusive disease has been reported to develop as a late complication of gemtuzumab ozogamicin treatment. A patient who developed Budd‐Chiari Syndrome with hepatic vein thrombosis following treatment with GO is presented. This complication has not been previously reported, and it deserves to be considered as a possible adverse effect of gemtuzumab ozogamicin. Am. J. Hematol. 80:213–215, 2005. © 2005 Wiley‐Liss, Inc.

Budd-Chiari Syndrome as an Initial Presentation of Non-Promyelocytic Acute Myelogenous Leukemia

“…In our case, BCS was likely secondary to undiagnosed AML on admission. On review of the literature, there are 10 reported cases of BCS in association with AML, of which seven cases were presented with BCS as an initial presentation of AML (Table 2) [5,[7][8][9][10][11][12][13][14]19]. Of the reported cases, seven cases occurred in APL, including one microgranular variant.…”

“…The patients may present with VTE as a presenting symptom of hematological malignancy [6]. There are only seven reported cases of acute myeloid leukemia (AML) presenting with acute BCS as the initial presentation in the literature [5,[7][8][9][10][11][12][13][14]. In patients presenting with acute BCS with ALF, a high index of suspicion and exclusion of underlying malignancy is a must, as it is a contraindication for liver transplantation (LT).…”

Budd-Chiari Syndrome during Long-term Follow-up after Allogeneic Umbilical Cord Blood Transplantation

“…In addition to HRT with estradiol and dydrogesterone, the Budd-Chiari syndrome in this case was suspected to be due to leukemia and HSCT used for its treatment. However, most cases of primary Budd-Chiari syndrome associated with leukemia are due to thrombosis associated with disseminated intravascular coagulopathy and rarely to intravenous infiltration of fungi from liver abscesses ( 5 , 6 ) or gemtuzumab ozogamicin ( 7 ). All of these conditions were considered to be different from the pathogenesis in this case, as they occur within a short period of time after the onset of leukemia and have an acute course.…”

What role does gemtuzumab ozogamicin have in the treatment of acute myelogenous leukemia?

“…Other serious toxicities also have been reported, such as a sensorimotor peripheral neuropathy mimicking Guillain-Barré syndrome [31], Budd-Chiari syndrome [32], and diffuse alveolar hemorrhage [33].…”