Chronic myeloid leukemia in solid organ transplant patients: a case series
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ORIGINAL ARTICLE
Chronic myeloid leukemia in solid organ transplant patients: a case series Irina Amitai1,4 · Adi Shacham Abulafia2,4 · Pia Raanani2,4 · Jeffrey H. Lipton3 Received: 29 July 2020 / Revised: 23 September 2020 / Accepted: 24 September 2020 © Japanese Society of Hematology 2020
Abstract Solid organ transplant (SOT) has transformed the survival and quality of life of patients with end-organ dysfunction. Lifelong need for immunosuppressive medications prolongs life expectancy, but results in altered immune function and is associated with a higher risk of certain malignancies, including chronic myeloid leukemia (CML). In this article, we report on six patients, aged 41–79 years, diagnosed with CML, from 3 to 132 months post-various organ transplants and treated with different tyrosine kinase inhibitors (TKI), including first generation (i.e., imatinib) and second generation (i.e., dasatinib and nilotinib). Use of second-generation TKIs has not been previously reported in this population. In these six cases, treatment with different TKIs in SOT patients was feasible, well tolerated and achieved good efficacy, which was maintained in extended follow-up, as well. Keywords Chronic myeloid leukemia · Solid organ transplant · Imatinib · Dasatinib · Nilotinib
Introduction Over 100,000 patients worldwide [1, 2] receive solid organ transplants (SOT) annually, and this number has been steadily increasing each year. The survival of transplant recipients has been improving in the past 2 decades, owing to the introduction of new medications to prevent acute rejection and other medical advances that enhance long-term maintenance * Irina Amitai [email protected] Adi Shacham Abulafia [email protected] Pia Raanani [email protected] Jeffrey H. Lipton [email protected] 1
Division of Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue TG 260, Toronto, ON M4N 3M5, Canada
2
Institute of Hematology, Davidoff Cancer Center, Rabin Medical Centre, Petah Tikva, Israel
3
Allogeneic Blood and Marrow Transplant Service, Princess Margaret Cancer Centre, Toronto, ON, Canada
4
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
of allografts. However, these patients exhibit increased risk for development of additional morbidities, including an increased risk for malignancies, largely thought to be related to immunosuppressive medications [3, 4]. Common malignancies observed in solid organ transplant recipients include skin carcinomas, post-transplant lymphoproliferative disorders (PTLD), Kaposi sarcoma, and renal cell carcinoma [5]. In contrast, myeloid neoplasms occurring after solid organ transplantation are rare. Reports of these disorders are limited mostly to a few small series and epidemiologic studies in the literature [6]. The first case of chronic myeloid leukemia (CML) in an organ transplant recipient was described back in 1976 [7]. A large cohort study of 207,859 solid organ transplants in the United States between the years 1987 and 2009 [8] r
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