Successful treatment of follicular lymphoma with second-generation tyrosine kinase inhibitors administered for coexisting chronic myeloid leukemia

Abstract

Tyrosine kinase inhibitors (TKIs) are standard therapy for chronic myeloid leukemia (CML). However, the effects of these agents on mature B cell lymphoma are not well known. We describe a 50-year-old man who was diagnosed with CML in the chronic phase and treated with imatinib. After 3 years of imatinib therapy that achieved a complete cytogenetic response of CML, he developed Philadelphia-negative follicular lymphoma (FL). Rituximab monotherapy induced a partial response of FL, and he subsequently achieved a major molecular response (MMR) of CML. Three years later, however, the MMR was lost, followed by the progression of FL. Imatinib was switched to nilotinib for the treatment of CML, while we chose watchful waiting for FL. He achieved MMR again under treatment with nilotinib for 8 months including one month of substitutional use of dasatinib due to adverse events, but thereafter nilotinib was switched to bosutinib due to hyperbilirubinemia. With the administration of second-generation TKIs (2G-TKIs) for a total of 18 months, he achieved a complete response to FL without antilymphoma treatment. This is the first report to suggest that 2G-TKIs may have direct or indirect effects on FL.

High‐grade B‐cell lymphoma developed during the treatment of chronic myeloid leukemia with bosutinib

“…Table 1 showed the detailed clinical course of lymphomas that developed during TKI treatment in CML patients. [10][11][12][13][14][15][16][17] Among them, imatinib was the most commonly used medication, while there were no reports of patients who were treated with bosutinib. The time from the initial TKI dose to the onset of the secondary cancer was longest in our case.…”

High grade B-cell lymphoma developed in the course of chronic myeloid leukemia treatment with bosutinib

“…Sasaki K et al reported 31 (0.2%) CML patients with secondary lymphoma, but their clinical courses are unknown. Table 1 showed the detailed clinical course of lymphomas that developed during TKI treatment in CML patients [10][11][12][13][14][15][16][17] . Among them, imatinib was the most commonly used medication, while there were no reports of patients who were treated with bosutinib.…”

Concurrent Diagnosis of Chronic Myeloid Leukemia and Follicular Lymphoma: An Unreported Presentation

“…Here, we present the third known case of a patient with nodal involvement by both FL and chronic phase-CML. Both previously documented cases occurred in patients with CML who developed follicular lymphoma after initial diagnosis [ 6 , 7 ].…”

“…Although he continued to receive imatinib, eventually achieving a major molecular remission, he subsequently lost this deeper response after another three years, followed by a progression of FL. Treatment with a second-generation TKI resulted not only in a major molecular remission of the CML, but also a complete remission for the FL [ 7 ]. As our patient had concurrent nodal involvement by CP-CML and FL at initial presentation, the presence of these two malignancies may represent independent events.…”