Boshkos Mitchell C, Nieves-Jiménez Humberto R, Thakkar Parin H, Cintrón-García Juan J, Mamlouk Omar
Department of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.
Case Rep Oncol Med. 2025 Sep 8;2025:9887771. doi: 10.1155/crom/9887771. eCollection 2025.
Renal artery stenosis (RAS) is a rare but significant vascular complication associated with nilotinib therapy for chronic myeloid leukemia (CML). We present the case of a woman in her mid-70s on long-term nilotinib who developed this adverse event. The patient presented with a progressive, insidious decline in renal function over several years. Diagnostic evaluation revealed severe unilateral stenosis of the left renal artery. Under nilotinib, the patient had maintained a sustained deep molecular response (DMR), making her a candidate for treatment-free remission (TFR). The development of RAS prompted the discontinuation of nilotinib, both as a therapeutic intervention for her kidney disease and to initiate a trial of TFR. Following discontinuation, the patient's renal function showed partial but significant improvement, suggesting a causal relationship. This case describes the importance of recognizing subtle presentations of TKI-induced vascular complications, particularly unilateral RAS, and illustrates how managing such adverse events intersects with modern CML therapeutic goals like TFR.
肾动脉狭窄（RAS）是一种与尼洛替尼治疗慢性粒细胞白血病（CML）相关的罕见但严重的血管并发症。我们报告了一例70多岁长期服用尼洛替尼的女性发生这一不良事件的病例。该患者在数年间肾功能呈进行性、隐匿性下降。诊断评估显示左肾动脉严重单侧狭窄。在服用尼洛替尼期间，患者维持了持续的深度分子反应（DMR），使其成为无治疗缓解（TFR）试验的候选者。RAS的发生促使停用尼洛替尼，这既是对其肾脏疾病的治疗干预，也是启动TFR试验的需要。停药后，患者的肾功能有部分但显著的改善，提示存在因果关系。本病例描述了认识TKI诱导的血管并发症（特别是单侧RAS）细微表现的重要性，并说明了处理此类不良事件与TFR等现代CML治疗目标之间的交叉情况。
