Successful Rechallenge with Imatinib in a Patient with Chronic Myeloid Leukemia Who Previously Experienced Imatinib Mesylate Induced Pneumonitis

Abstract

Imatinib mesylate is a targeted therapy that acts by inhibiting tyrosine kinase of the bcr-abl fusion oncoprotein, which is specific to chronic myeloid leukemia (CML), and the c-transmembrane receptor, which is specific to gastrointestinal stromal tumors. Interstitial pneumonitis is a rare adverse event of imatinib therapy. It is clinically difficult to distinguish from infectious pneumonia, which can frequently occur due to the underlying disease. The standard treatment for imatinib-induced pneumonitis is to discontinue the medication and optionally administer corticosteroids. However, there are a few cases of successful retrial with imatinib. We describe a case of successful rechallenge of imatinib in a patient with imatinib-induced interstitial pneumonitis and CML without a recurrence of the underlying disease after 3 months of follow-up.

A Rare Case of Imatinib-Induced Pneumonitis

“…Incidence appears to be higher in those with pre-existing lung disease [5]. In the present case, the development of pneumonitis occurred after five months of treatment.…”

“…Imatinib pneumonitis appears to develop on average approximately two months after commencing treatment with a median dose of 400mg imatinib [4,5]. Incidence appears to be higher in those with pre-existing lung disease [5].…”

“…Serial imaging may be required to ensure resolution. A re-challenge with imatinib may be considered when the patient has displayed improvement both clinically and radiologically [5,15].…”

Imatinib mesylate in the management of chemotherapy-induced pulmonary toxicity: a double-edged sword

“…On the other hand, although not frequent, it was shown that IM can also induce pneumonitis in patients with CML [6][7][8]. In the study by Ohnishi et al [9], among 5500 patients receiving IM, there were 27 cases of interstitial lung disease.…”

“…Surgery is the preferred therapy if the metastases are resectable, and chemotherapy is an option when surgery is not feasible. The drugs used at relapse are usually gemcitabine and docetaxel [response rates (RR) 15-30%] [5][6][7], high-dose ifosfamide [RR 30-40%] [8,9] or etoposide.…”