Hatsuse Mayumi, Daikoku Yuka, Tamoto Yuta, Uehara Masahiro, Kitani Takashi, Tamagaki Keiichi, Fuchida Shin-Ichi, Okano Akira, Murakami Satoshi, Shimazaki Chihiro
Department of Hematology, Japan Community Health care Organization, Kyoto Kuramaguchi Medical Center.
Rinsho Ketsueki. 2017;58(1):15-19. doi: 10.11406/rinketsu.58.15.
A 63-year-old male was diagnosed as having chronic phase CML in 2001. He obtained a major molecular response with imatinib (IM). In 2012, amulodipin was started for hypertension. In January 2013, IM was switched to nilotinib (NIL) in a clinical trial, and in February 2015, NIL was discontinued because MR had been maintained for two years. One month later, he was admitted to our hospital because of headache and high blood pressure (194/108 mmHg). His urine test showed protein 3+ and occult blood 2+. His eGFR rapidly deteriorated from 45.6 to 28.5 after admission. MR angiography showed left renal artery stenosis. He thus underwent angioplasty of the left renal artery with a stent implantation. His renal function subsequently improved. Cardiovascular events such as PAOD (peripheral artery occlusive disease) during NIL treatment were recently reported. However, to date, only four cases including our present patient with renal artery stenosis associated with NIL have been reported. These observations suggest assessment of risk factors for cardiovascular events at the start of NIL and careful monitoring to be important during tyrosine kinase inhibitor treatment of CML patients.
一名63岁男性于2001年被诊断为慢性期慢性粒细胞白血病。他使用伊马替尼（IM）获得了主要分子反应。2012年，开始使用氨氯地平治疗高血压。2013年1月，在一项临床试验中IM换为尼洛替尼（NIL），2015年2月，由于主要反应已维持两年，停用NIL。一个月后，他因头痛和高血压（194/108 mmHg）入住我院。尿检显示蛋白3+，潜血2+。入院后他的估算肾小球滤过率（eGFR）从45.6迅速恶化至28.5。磁共振血管造影显示左肾动脉狭窄。因此他接受了左肾动脉血管成形术并植入支架。随后他的肾功能得到改善。最近有报道尼洛替尼治疗期间发生诸如外周动脉闭塞性疾病（PAOD）等心血管事件。然而，迄今为止，包括我们目前这位患有与尼洛替尼相关的肾动脉狭窄患者在内，仅报道了4例。这些观察结果表明，在尼洛替尼治疗开始时评估心血管事件的危险因素以及在慢性粒细胞白血病患者酪氨酸激酶抑制剂治疗期间进行仔细监测很重要。
