Suppr超能文献

缺铁性贫血:达沙替尼治疗的慢性髓性白血病患者巨细胞病毒诱导的出血性结肠炎的早期临床表现。

Iron deficiency anemia: an early clinical presentation of cytomegalovirus-induced hemorrhagic colitis in chronic myeloid leukemia patients under dasatinib treatment.

作者信息

Sanchez-Paz Laura, Tirado Zambrana Pernilla Seidi, Villa Poza Carlos, Hernández-Rivas José-Ángel, Landete Hernández Elena

机构信息

Hematology Department, Infanta Leonor University Hospital, Avda Gran Via del Este, nº80, Vallecas, Madrid 28031, Spain.

Pathology Department, Infanta Leonor University Hospital, Madrid, Spain.

出版信息

Ther Adv Hematol. 2024 Oct 25;15:20406207241291736. doi: 10.1177/20406207241291736. eCollection 2024.

Abstract

Dasatinib is a second-generation tyrosine kinase inhibitor employed for chronic myeloid leukemia (CML) treatment that achieves high rates of prolonged and complete molecular responses (MR). Among the adverse effects reported, it has been associated with hemorrhagic complications, mainly due to its inhibiting effects on platelet functions. In addition, immune alterations induced by dasatinib may elevate the risk of bleeding and cytomegalovirus (CMV) infection, particularly in the gastrointestinal tract, thus contributing to the development of hemorrhagic colitis. In this case report, we highlight three cases of CML receiving treatment with dasatinib where CMV hemorrhagic colitis occurred. All of them exhibited iron deficiency anemia as a premature clinical manifestation in the absence of intestinal symptoms, unlike cases previously reported in the literature. CMV infection was confirmed with stool samples or tissue quantitative polymerase chain reaction and/or immunohistochemistry staining in colon biopsies. All three cases could be managed with valganciclovir and iron supplements in an outpatient setting. Management strategies of dasatinib during and after CMV infection varied, as they are not yet established and need to be individualized based on the gravity of symptoms and disease state. Iron deficiency anemia during dasatinib treatment should raise suspicion for the potential presence of CMV colitis, prompting endoscopic studies to rule out this complication, even if intestinal symptoms are not present.

摘要

达沙替尼是一种用于治疗慢性髓性白血病(CML)的第二代酪氨酸激酶抑制剂,可实现较高的长期完全分子反应(MR)率。在已报道的不良反应中,它与出血并发症有关,主要是由于其对血小板功能的抑制作用。此外,达沙替尼诱导的免疫改变可能会增加出血和巨细胞病毒(CMV)感染的风险,尤其是在胃肠道,从而导致出血性结肠炎的发生。在本病例报告中,我们重点介绍了3例接受达沙替尼治疗的CML患者发生CMV出血性结肠炎的情况。与先前文献报道的病例不同,所有患者在没有肠道症状的情况下均表现为缺铁性贫血这一早期临床表现。通过粪便样本或组织定量聚合酶链反应和/或结肠活检中的免疫组织化学染色确诊为CMV感染。所有3例患者均可在门诊使用缬更昔洛韦和铁补充剂进行治疗。CMV感染期间及之后的达沙替尼管理策略各不相同,因为尚未确立这些策略,需要根据症状的严重程度和疾病状态进行个体化处理。达沙替尼治疗期间的缺铁性贫血应引起对CMV结肠炎潜在存在的怀疑,即使没有肠道症状,也应促使进行内镜检查以排除这种并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ed2b/11528592/705e9fcf15b6/10.1177_20406207241291736-fig1.jpg

相似文献

4
Cytomegalovirus-induced Hemorrhagic Colitis in a Patient with Chronic Myeloid Leukemia (Chronic Phase) on Dasatinib as an Upfront Therapy.
Clin Med Insights Case Rep. 2015 Aug 26;8:77-81. doi: 10.4137/CCRep.S25327. eCollection 2015.
5
Severe hemorrhagic colitis in a patient with chronic myeloid leukemia in the blastic phase after dasatinib use.
World J Gastrointest Pathophysiol. 2013 Aug 15;4(3):59-62. doi: 10.4291/wjgp.v4.i3.59.
7
Dasatinib-induced colitis: clinical, endoscopic and histological findings.
Scand J Gastroenterol. 2022 Apr;57(4):449-456. doi: 10.1080/00365521.2021.2022190. Epub 2022 Jan 1.
8
Dasatinib-Induced Colitis after Allogeneic Stem Cell Transplantation for Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia.
Biol Blood Marrow Transplant. 2016 Oct;22(10):1900-1903. doi: 10.1016/j.bbmt.2016.06.022. Epub 2016 Jun 23.
9
A Case of Dasatinib-Induced Hemorrhagic Colitis Diagnosed by the Lymphocyte Transformation Test in a Chronic Myeloid Leukemia Patient.
Indian J Hematol Blood Transfus. 2016 Jun;32(Suppl 1):96-99. doi: 10.1007/s12288-015-0528-z. Epub 2015 Mar 18.
10
Cytomegalovirus colitis in intensive care unit patients: difficulties in clinical diagnosis.
J Crit Care. 2014 Jun;29(3):474.e1-6. doi: 10.1016/j.jcrc.2014.01.003. Epub 2014 Jan 13.

引用本文的文献

本文引用的文献

1
Chronic myeloid leukemia: 2022 update on diagnosis, therapy, and monitoring.
Am J Hematol. 2022 Sep;97(9):1236-1256. doi: 10.1002/ajh.26642. Epub 2022 Jul 6.
2
Comparative clinical manifestations and immune effects of cytomegalovirus infections following distinct types of immunosuppression.
Clin Microbiol Infect. 2022 Oct;28(10):1335-1344. doi: 10.1016/j.cmi.2022.05.034. Epub 2022 Jun 13.
3
Dasatinib-induced colitis: clinical, endoscopic and histological findings.
Scand J Gastroenterol. 2022 Apr;57(4):449-456. doi: 10.1080/00365521.2021.2022190. Epub 2022 Jan 1.
5
Cytomegalovirus colitis with presentation of hemorrhagic colitis in chronic myeloid leukemia during dasatinib therapy.
J Formos Med Assoc. 2021 Apr;120(4):1155-1157. doi: 10.1016/j.jfma.2020.10.009. Epub 2020 Oct 27.
6
Tyrosine Kinase Inhibitors Available for Chronic Myeloid Leukemia: Efficacy and Safety.
Front Oncol. 2019 Jul 3;9:603. doi: 10.3389/fonc.2019.00603. eCollection 2019.
8
Dasatinib-induced hemorrhagic colitis complicated with cytomegalovirus infection.
Hematol Rep. 2017 Dec 22;9(4):7415. doi: 10.4081/hr.2017.7415.
9
The incidence and natural history of dasatinib complications in the treatment of chronic myeloid leukemia.
Blood Adv. 2017 May 15;1(13):802-811. doi: 10.1182/bloodadvances.2016003889. eCollection 2017 May 23.
10
Cytomegalovirus-induced Hemorrhagic Colitis in a Patient with Chronic Myeloid Leukemia (Chronic Phase) on Dasatinib as an Upfront Therapy.
Clin Med Insights Case Rep. 2015 Aug 26;8:77-81. doi: 10.4137/CCRep.S25327. eCollection 2015.

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验