Gilteritinib
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Gilteritinib Neutropenia and thrombocytopenia: case report
A man in late 30s [exact age at the onset of event not stated] developed neutropenia and thrombocytopenia during treatment with gilteritinib for acute myeloid leukaemia (AML). The man was diagnosed with AML associated with myelodysplasia-related changes with FLT3-ITD (internal tandem duplication) mutation at the age of 38 years. He started receiving induction therapy with idarubicin and cytarabine. However, there was no complete remission with the therapy. Then he underwent allogenic bone marrow transplantation (allo-BMT) from human leukocyte antigen donor. After 3 months of diagnosis, he was started on myeloablative conditioning regimen with busulfan and cyclophosphamide due to one locus mismatched unrelated donor. Further examination revealed imminent haematological relapse of AML. His treatment with immunosuppressants was discontinued, and he received two courses of donor leukocyte infusion (DLI). Additionally, he had chronic graft versus host disease (GVHD), which causes dry eye, dry mouth and idiopathic pneumonia syndrome. He was treated with prednisolone and ciclosporin [cyclosporine] to control the GVHD. Approximately 400 days later, he was diagnosed with haematolymphoid neoplasm with a large number of cells having atypical nuclei and scant cytoplasm. Bone marrow examination showed increased AML blasts and these cells both in the extramedullary and medullary harbored FLT3-ITD mutation. Therefore, from day-446, he started receiving treatment with gilteritinib 120 mg/day [route not stated]. Following 20 days, a remarkable regression of tumour was noted. After 126 days of gilteritinib initiation, he achieved a complete molecular response in bone maarow and CT scan confirmed the disappearance of tumors. However, during treatment, he developed grade 4 adverse events including severe neutropenia and thrombocytopenia secondary to gilteritinib [time to reactions onsets not stated]. The man’s treatment with gilteritinib was temporarily withheld or reduced, as per requirement. Also, he was treated with several rounds of platelet transfusions. These treatment measures resulted in improvement of adverse events. The dose of gilteritinib was stabilised at 80 mg/day. Thereafter, he underwent second allo-BMT. After 48 days of allo-BMT, gilteritinib was restarted at dosage of 80 mg/day. A complete molecular response was maintained for 150 days after allo-BMT with no worsening of GVHD. Kumode T, et al. Targeted therapy for medullary and extramedullary relapse of FLT3-ITD acute myeloid leukemia following allogeneic hematopoietic stem cell transplantation. Leukemia Research Reports 14: 100219, 7 Aug 2020. Available from: URL: http://doi.org/10.1016/j.lrr.2020.100219
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Reactions 3 Oct 2020 No. 1824
