Both İmatinib and Nilotinib Treatment Associated Grade 3-4 Skin Rash, is it Predictable Before Tyrosine Kinase Inhibitor Treatment? A Case Report

Öz

Chronic myeloid leukemia (CML), characterized with The Philadelphia (Ph) chromosome, is a myeloproliferative disorder. Imatinib mesylate, the first selective tyrosine kinase inhibitor targeting Bcr-Abl protein. Nilotinib and dasatinib are second-generation tyrosine kinse inhibitörse, that have been approved for imatinib resistant CML. Most common side effects of these tyrosine kinase inibitors are myelosuppresion, nausea, vomiting, diarrhea and grade 1-2 skin rash. Due to imatinib treatment incidence of grade 3-4 skin rash is 3-5% and nilotinib treatment incidence grade 3-4 skin rash is <1%. Philadelphia(Ph) chromosome positive chronic phase CML were diagnosed to 50-year-old female patient with leukocytosis, and started treatment with imatinib. In the third month of treatment with imatinib was seen itchy, raised skin lesions and skin biopsy was performed on the identification. It is evaluated as drug eruption associated imatinib, so imatinib interrupted and then nilotinib treatment 2*400 mg/day was started. In the third year of nilotinib treatment hyperemic lesions and itching was detected and nilotinib treatment dose reduced 2*200 mg/day and local steroid treatment started. In the eighth year of treatment with nilotinib was seen grade 3-4 rash (figure1) and treatment was delayed and systemic steroid treatment was added. Because of development grade 3-4 skin rash, nilotinib could not resumed and was replaced with dasatinib treatment. Both two tyrosine kinase inhibitör treatment with in our patients with grade 3-4 skin rash, skin reactions under dasatinib continues to be closely monitored.

Anahtar Kelimeler

• skin rash,tyrosine kinase inhibitor

Hem İmatinib Hem de Nilotinib Tedavisi altında Gelişen Grade 3-4 Cilt Döküntüsü, Tirozin Kinaz İnhibitörü Başlamadan Öngörülebilir mi? Olgu sunumu

Öz

Kronik miyeloid lösemi (KML), Philadelphia (Ph) kromozomu pozitifliği ile karakterize kronik miyeloproliferatif bir hastalıktır. İmatinib mesylate, BCR-ABL proteinini hedef alan ilk seçici tirozin kinaz inhibitörüdür (TKI). Nilotinib ve dasatinib ise imatinib dirençli KML tedavisinde kullanılan 2.kuşak tirozin kinaz inhibitörleridir. Bu tirozin kinaz inhibitörlerinin en sık görülen yan etkileri miyelosupresyon, bulantı, kusma, ishal ve grade 1-2 cilt döküntüleridir. İmatinibe bağlı grade 3-4 cilt döküntüsünün görülme olasılığı %3-5, nilotinibe bağlı grade 3-4 cilt döküntüsünün görülme olasılığı ise <%1’dir. Olgumuz 50 yaşındaki kadın hastaya lökositoz nedenli Ph kromozomu pozitif kronik faz KML tanısı konuldu ve imatinib tedavisi başlandı. İmatinib tedavisinin 3. ayında kaşıntılı, ciltten kabarık lezyonlar saptanması üzerine cilt biyopsisi yapıldı ve ilaç erupsiyonu olarak değerlendirilerek imatinib tedavisi kesildi, nilotinib 2*400 mg/gün başlandı. Nilotinib tedavisinin 3.yılında ciltte hiperemik lezyonlar ve kaşıntı saptanması üzerine nilotinib tedavisi 2*200 mg/gün dozuna düşürüldü ve lokal tedavi başlandı. Nilotinib tedavisinin 8.yılında grade 3-4 cilt döküntüsü gelişen hastada tedaviye ara verildi ve sistemik steroid eklendi. Grade 3-4 döküntü gelişmesi nedeni ile nilotinib tekrar başlanamadı, ve tedavisi dasatinib ile değiştirildi. TKI ile grade 3-4 cilt döküntüsü gelişen hastamızda, dasatinib altında da cilt reaksiyonu gelişip-gelişmeyeceği açısından yakın takip devam etmektedir.

Anahtar Kelimeler

• cilt döküntüsü,tirozin kinaz inhibitörü

Kaynakça

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