Kamijo Kimimori, Shimomura Yoshimitsu, Yamashita Daisuke, Ishikawa Takayuki
Department of Hematology, Kobe City Hospital Organization Kobe City Medical Center General Hospital, Kobe, Japan.
Department of Pathology, Kobe City Hospital Organization Kobe City Medical Center General Hospital, Kobe, Japan.
Case Rep Oncol. 2021 Jul 19;14(2):1139-1143. doi: 10.1159/000517442. eCollection 2021 May-Aug.
Here, we present a rare case of tyrosine kinase inhibitor (TKI)-induced bone marrow aplasia. A 58-year-old man presented with leukocytosis and was diagnosed with chronic myeloid leukemia. He was initially treated with imatinib for 6 years and abruptly discontinued treatment by himself. He was administered dasatinib 5 years after treatment interruption, and presented with pancytopenia 6 months after dasatinib initiation. Bone marrow biopsy revealed severe hypocellularity without blasts. Dasatinib was discontinued, and he recovered from pancytopenia 3 months later; however, was positive for almost all white blood cells in the peripheral blood. We retreated with ponatinib, but pancytopenia developed again. The clinical course indicated TKI-induced bone marrow aplasia. Therefore, ponatinib was discontinued and the patient received an allogeneic hematopoietic stem cell transplantation from a haploidentical daughter using post-transplant cyclophosphamide. He had a major molecular response and had normal complete blood counts and bone marrow 1 year after transplantation.
在此，我们报告一例罕见的酪氨酸激酶抑制剂（TKI）诱导的骨髓再生障碍病例。一名58岁男性因白细胞增多症就诊，被诊断为慢性髓性白血病。他最初接受伊马替尼治疗6年，后自行突然停药。在治疗中断5年后给予达沙替尼治疗，达沙替尼起始治疗6个月后出现全血细胞减少。骨髓活检显示严重细胞减少，无原始细胞。停用达沙替尼，3个月后他从全血细胞减少中恢复；然而，外周血几乎所有白细胞均呈阳性。我们再次使用波纳替尼治疗，但全血细胞减少症再次出现。临床病程提示为TKI诱导的骨髓再生障碍。因此，停用波纳替尼，患者接受了来自单倍体相合女儿的异基因造血干细胞移植，并使用移植后环磷酰胺。移植1年后，他获得了主要分子反应，全血细胞计数和骨髓均正常。
