Hattori Hideki, Kuwayama Maki, Takamori Hiroyuki, Nishiura Nobuko, Karasuno Takahiro
Department of Hematology, Yao Municipal Hospital.
Rinsho Ketsueki. 2014 Dec;55(12):2429-32. doi: 10.11406/rinketsu.55.2429.
We report a 77-year-old Japanese man with idiopathic thrombocytopenic purpura (ITP) which developed into chronic myelogenous leukemia (CML) during treatment with eltrombopag, a thrombopoetin (TPO) receptor agonist, because the disease was refractory to prednisolone. Eltrombopag can induce a good reaction in terms of the platelet count. However, CML in the chronic phase developed in about 19 months in our present case. Dasatinib was administered because he had diabetes. However, a blastic crisis immediately occurred. He died despite switching to Nilotinib. Recently, the occurrence of myelofibrosis and hematological malignancies due to long-term use of TPO receptor agonists has become a concern. This is the first report of a TPO receptor agonist possibly contributing to CML onset and crisis.
我们报告了一名77岁的日本男性，他患有特发性血小板减少性紫癜（ITP），由于该疾病对泼尼松龙难治，在使用促血小板生成素（TPO）受体激动剂艾曲泊帕治疗期间发展为慢性粒细胞白血病（CML）。艾曲泊帕在血小板计数方面可诱导良好反应。然而，在我们目前的病例中，约19个月后出现了慢性期CML。由于他患有糖尿病，给予了达沙替尼治疗。然而，立即发生了急变期。尽管改用尼罗替尼，他仍死亡。最近，长期使用TPO受体激动剂导致骨髓纤维化和血液系统恶性肿瘤的发生已成为一个关注点。这是关于TPO受体激动剂可能促成CML发病和急变期的首例报告。
