Chronic Myeloid Leukemia in a Patient with Previous Idiopathic Thrombocytopenic Purpura: How to Manage Imatinib Together with Eltrombopag

Abstract

The occurrence of chronic myeloid leukemia (CML), or other myeloproliferative diseases, after the development of idiopathic thrombocytopenic purpura (ITP) is very rare in the current medical literature. Considering the advances in ITP management, and the wide use of new drugs for ITP and CML, we report an unusual case with this association. Our case report focused on a 64-year-old man with long-standing ITP treated with eltrombopag, who developed hyperleukocytosis during follow-up; after specific laboratory exams, it was diagnosed as CML and he began treatment with imatinib. The treatment with eltrombopag was balanced with imatinib to stabilize his platelet count. Data on bcr-abl and JAK2 transcripts were collected and revealed an optimal response with the achievement of negativization of both molecular signatures. We could demonstrate that treatment with imatinib and eltrombopag was well tolerated and allowed complete molecular remission of CML to be achieved, as well as of ITP.

Improvement of immune thrombocytopenia with imatinib therapy following chronic myeloid leukemia

“…Two of them were pediatric ITP cases who later became refractory to corticosteroids and splenectomy and developed CML 7.5 or 29 years after the initial diagnosis of ITP [2,3]. The others were adult cases who developed CML 5 or 15 years after the diagnosis of ITP [4,5]. In these case reports, at the diagnosis of CML, platelet count remained low in one case, normalized in another case, and elevated in the other two cases.…”

“…In these case reports, at the diagnosis of CML, platelet count remained low in one case, normalized in another case, and elevated in the other two cases. Notably, both of adult cases had been treated by eltrombopag, a thrombopoietin (TPO) receptor agonist, after ITP became refractory to corticosteroids [4,5]. In these reports, the possibility was postulated that long-term use of TPO receptor agonist would promote the onset of CML.…”

“…Immune thrombocytopenia (ITP) is an autoimmune disease characterized by anti-platelet autoantibodies, due to an abnormal T cell response that stimulates the proliferation and differentiation of autoreactive B cells [1]. Although the association of autoimmune disorders and hematologic neoplasms has been well recognized, ITP and chronic myeloid leukemia (CML) are rarely observed concurrently [2][3][4][5][6].…”