Department of Hematology, Eiju General Hospital, 2-23-16, Higashi-Ueno, Taito-ku, Tokyo 110-8645, Japan.
Int J Hematol. 2013 Aug;98(2):243-6. doi: 10.1007/s12185-013-1356-2. Epub 2013 May 7.
Nilotinib, a second-generation tyrosine kinase inhibitor with 20- to 30-fold greater potency than imatinib, was developed to overcome imatinib intolerance or resistance. Recently, nilotinib has been approved as a first-line treatment for chronic myelogenous leukemia in the US and Japan. Tumor lysis syndrome (TLS) is an extremely rare adverse event that can occur during treatment with nilotinib, with only a few reported cases to date. Herein, we report two patients who developed TLS soon after the start of treatment with nilotinib. While in the first case, which co-presented with underlying mild-to-moderate renal insufficiency due to polycystic kidney disease, the TLS resolved on discontinuation of the drug, the second patient, who had an exceedingly high white blood cell count, presented with disseminated intravascular coagulation and severe liver injury triggered by TLS that developed after the start of nilotinib treatment, and died of multiple organ failure. Therefore, caution is necessary when this drug is used in the first-line setting in patients with renal insufficiency or a high tumor burden.
尼洛替尼是一种第二代酪氨酸激酶抑制剂，其活性比伊马替尼高 20-30 倍，旨在克服伊马替尼不耐受或耐药。最近，尼洛替尼已在美国和日本被批准作为慢性髓性白血病的一线治疗药物。肿瘤溶解综合征（TLS）是一种非常罕见的不良反应，在使用尼洛替尼治疗期间可能会发生，迄今为止仅有少数报道病例。在此，我们报告了两例患者在开始使用尼洛替尼后不久即发生 TLS。在第一个病例中，由于多囊肾病导致轻度至中度肾功能不全，TLS 在停药后得到缓解；而第二个患者的白细胞计数极高，在开始使用尼洛替尼后出现由 TLS 引发的弥散性血管内凝血和严重肝损伤，最终因多器官衰竭而死亡。因此，在肾功能不全或肿瘤负荷高的患者中，该药物作为一线治疗药物使用时需要谨慎。
