Vasospastic angina in a chronic myeloid leukemia patient treated with nilotinib

Abstract

Background Nilotinib, a second-generation BCR-ABL tyrosine kinase inhibitor (TKI), is highly effective in the treatment of patients with chronic myeloid leukemia (CML), despite being more vasculotoxic than older TKIs such as imatinib. Herein, we present a case of nilotinib-associated vasospastic angina confirmed by an acetylcholine spasm provocation test. Case presentation A 62-year-old CML patient treated with 300 mg nilotinib twice daily complained of several episodes of rest angina and was hospitalized at our institution. Coronary angiography revealed no severe organic stenosis, and the acetylcholine spasm provocation test confirmed the diagnosis of vasospastic angina. Although treatment with a calcium channel blocker and nicorandil reduced the frequency of chest pain, angina symptoms continued to occur. At 10 months post discharge, the patient complained of increased frequency of angina; therefore, the nilotinib dosage was reduced to 150 mg twice daily. Consequently, the patient reported a significant improvement in chest symptoms. Conclusions This case report highlights the potential vasculotoxic effects of nilotinib. Cardiologists and hematologists should be vigilant for coronary artery spasm as a possible vascular adverse event caused by nilotinib.

Nilotinib related acute myocardial infarction with nonobstructive coronary arteries: a case report and literature review

“…Lipid metabolism disorder [ 14 ], endothelial dysfunction [ 9 ] and inflammation overactivation [ 15 ] are several suggested mechanisms, which can accelerate atherosclerotic process and cause vascular spasm [ 16 ]. To the best of our knowledge, there have been only three cases reported of nilotinib related coronary spasm [ 17 , 18 ]. No CAS induced MINOCA related to nilotinib has been previously reported.…”