Tremblay Douglas, Putra Juan, Vogel Alexander, Winters Adam, Hoffman Ronald, Schiano Thomas D, Fiel Maria Isabel, Mascarenhas John O
Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Case Rep Hematol. 2019 Jan 6;2019:3294046. doi: 10.1155/2019/3294046. eCollection 2019.
Ruxolitinib is increasingly being utilized for the treatment of myelofibrosis and polycythemia vera, but the potential for hepatic toxicity is poorly understood. We performed a retrospective review of hepatic damage occurring in patients with myeloproliferative neoplasms receiving ruxolitinib. Relevant histologic images of liver biopsies were reviewed by an experienced liver pathologist and reported to a multidisciplinary team including hepatology and hematology. A variety of liver pathology was observed including extramedullary hematopoiesis, obliterative portal venopathy, and drug-induced liver injury. In all cases reviewed, the liver biopsy had significant treatment implications. We conclude that hepatology referral and liver biopsy in patients receiving ruxolitinib therapy with biochemical evidence of liver injury reveals a variety of etiologies which have significant treatment impact. Clinicians should be aware of the potential causes of liver damage in this population and initiate prompt referral and liver biopsy.
芦可替尼越来越多地用于治疗骨髓纤维化和真性红细胞增多症，但对其肝毒性的潜在影响了解甚少。我们对接受芦可替尼治疗的骨髓增殖性肿瘤患者发生的肝损伤进行了回顾性研究。由一位经验丰富的肝脏病理学家对肝脏活检的相关组织学图像进行审查，并向包括肝病学和血液学在内的多学科团队报告。观察到多种肝脏病理情况，包括髓外造血、闭塞性门静脉病和药物性肝损伤。在所有审查的病例中，肝脏活检对治疗具有重要意义。我们得出结论，对于接受芦可替尼治疗且有肝损伤生化证据的患者，转诊至肝病科并进行肝脏活检可发现多种病因，这些病因对治疗有重大影响。临床医生应了解该人群肝损伤的潜在原因，并及时进行转诊和肝脏活检。
