TKI-induced pure red cell aplasia: first case report of pure red cell aplasia with both imatinib and nilotinib

Poudyal, Bishesh Sharma; Tuladhar, Sampurna; Gyawali, Bishal

doi:10.1136/esmoopen-2016-000058

Cited by 5 publications

(7 citation statements)

References 13 publications

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“…Aplastic anemia (AA) has been reported in other first and second generation TKIs, with several case reports of AA and/or aplasia due to imatinib 5–8 and nilotinib 9–11 in the literature. 12 There have been no previously reported cases due to dasatinib, although dasatinib was observed to cause continued cytopenias in a prior case of imatinib induced aplastic anemia. 13 While they have revolutionized the care of patients with CML, TKIs are not benign medications, and knowing each of their unique and overlapping potential side effects is vital.…”

Section: Discussionmentioning

confidence: 99%

Unexpected pancytopenia: Dasatinib induced aplastic anemia in chronic myeloid leukemia

Feld

Steinberg

Jamal

et al. 2021

J Oncol Pharm Pract

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Introduction The use of TKIs in CML has dramatically altered the natural course of the disease and improved outcomes for patients. TKIs overall have a very favorable safety profile. Dasatinib, a second generation TKI, is commonly used as a first-line treatment option in CML. Case report We describe the first two reported cases of first-line dasatinib induced aplastic anemia in CML. In both patients, pancytopenia occurred within one year of diagnosis/starting dasatinib. Both bone marrow biopsies showed hypocellularity with mild fibrosis and persistent BCR-Abl1 positivity. Management & outcome Dose reduction was attempted without success in both patients. In one patient, multiple TKIs were trialed, while in the other, growth factor support was attempted; neither regimen was effective. Ultimately, the cytopenias associated with dasatinib were only resolved after immunosuppression in one patient and allogeneic stem cell transplant in the other patient. Discussion Prior reports have shown that aplasia/aplastic anemia can rarely be associated with imatinib and nilotinib. Here we show that dasatinib can lead to this phenomenon as well. This diagnosis should be considered in patients with CML who unexpectedly develop cytopenias.

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Section: Discussionmentioning

confidence: 99%

Unexpected pancytopenia: Dasatinib induced aplastic anemia in chronic myeloid leukemia

Feld

Steinberg

Jamal

et al. 2021

J Oncol Pharm Pract

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“…In 2016, a case of pure red cell aplasia was described as induced by Imatinib and Nilotinib. 8 A few published cases of patients developing aplastic anemia after exposure to a single BCR-ABL TKI were reported. 5 It's the first case out of 160 patients with CML following in the south of Tunisia which developed a persistent severe aplastic anemia unresponsive to TKI discontinuation.…”

Section: Discussionmentioning

confidence: 99%

Aplastic anemia secondary to tyrosine kinase inhibitor therapy in a patient with chronic myeloid leukemia

Kassar

Mallek

Saïd

et al. 2021

J Oncol Pharm Pract

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Introduction Nilotinib, as the second generation of tyrosine kinase inhibitor, has significant efficacy in patients with chronic myeloid leukemia resistant or intolerant to Imatinib. Aplastic anemia induced by tyrosine kinase inhibitors is an uncommon complication. Case report A 34-year-old female case with CML in the chronic phase was treated with Imatinib in first-line therapy. Nilotinib was switched because of failure to achieve complete cytogenetic response at 6 months following Imatinib. Three years with Nilotinib, the patient developed a persistent pancytopenia grade 4 while a major molecular response was achieved. Management & Outcome Nilotinib was discontinued. However, the hematologic finding of the patient had not recovered after three months. A bone marrow biopsy showed marked hypocellularity and fatty tissue without evidence of myelofibrosis. Immunosuppressive therapy was started. Unfortunately, the patient died due to septic and hemorrhagic shock nine months after Nilotinib interruption. According to Naranjo's algorithm, the causality relationship with the drug is probable with a score of 5. Discussion Aplastic anemia is an uncommon adverse event of tyrosine kinase inhibitors but it can be a fatal complication. The early diagnosis of aplastic anemia related to Nilotinib therapy is needed to avoid further detrimental effects of the drug.

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“…Cytopenias are known to occur during treatment of CML. In 2016, Poudyal et al described a patient who developed pure red cell aplasia (PRCA) from treatment with imatinib and nilotinib [3]. Sumi, Khan, Estephan, Prodduturi, Lokeshwar, and Song have each described patients developing aplasia after exposure to single BCR-ABL TKI (Table 1) [4–9].…”

Section: Discussionmentioning

confidence: 99%

Aplasia in Chronic Phase CML Post-TKI Therapy: A Management Dilemma

Ramdial

Aguirre

Ali

et al. 2019

Case Reports in Hematology

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Transient cytopenias and bone marrow hypoplasia commonly occur during treatment of CML with TKIs (tyrosine kinase inhibitors). This is usually related to the eradication of CML clones that initially compose the majority of hematopoietic cells in the bone marrow at the time of diagnosis. With continuation of effective therapy, normal blood counts return as normal hematopoiesis is restored and CML clones are reduced. Though rare and more unusual than myelodysplastic syndrome (MDS), isolated instances of persistent marrow aplasia have been documented with chronic use of TKIs. We describe two such instances of chronic phase CML where no significant reduction of CML clones was achieved following treatment with TKIs, but bone marrow aplasia occurred resulting in persistent dysfunctional hematopoiesis. Due to prolonged aplasia/hypoplasia, such patients are no longer amenable to TKI treatment. CML progression to accelerated or blast phase in that setting would likely be fatal.

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TKI-induced pure red cell aplasia: first case report of pure red cell aplasia with both imatinib and nilotinib

Cited by 5 publications

References 13 publications

Unexpected pancytopenia: Dasatinib induced aplastic anemia in chronic myeloid leukemia

Unexpected pancytopenia: Dasatinib induced aplastic anemia in chronic myeloid leukemia

Aplastic anemia secondary to tyrosine kinase inhibitor therapy in a patient with chronic myeloid leukemia

Aplasia in Chronic Phase CML Post-TKI Therapy: A Management Dilemma

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