Nilotinib
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Liver injury: case report A 59-year-old woman developed liver injury during treatment with nilotinib for chronic myeloid leukaemia. The women had a history of chronic myeloid leukaemia and received initial treatment with dasatinib. However, dasatinib was switched to nilotinib 300 mg twice a day [route not stated] due to intractable pleural effusion. Four months following treatment with nilotinib, her serum aminotransferase level was found to be elevated. Hence, the woman’s treatment with nilotinib was temporarily discontinued and the liver enzymes normalised. A month later, treatment with nilotinib was restated and an increase liver enzyme was observed. The woman was admitted to liver clinic. Her laboratory investigations showed the followings: haemoglobin 13.8 g/dL, leukocyte count 4320/µL, platelet count 123000/µL, aspartate aminotransferase 578 IU/L, alanine aminotransferase 499 IU/L, alkaline phosphatase 110 IU/L, gammaglutamyl transferase 180 U/L, total bilirubin 1.51 mg/dL, serum immunoglobulin G 1383 mg/dL, and the antinuclear antibody titer 1:320. Her serological and antibody testing were negative. Ultrasonography showed a mild increase in peripheral echogenicity without biliary obstruction or chronic liver disease. Percutaneous needle liver biopsy was performed on the second day and revealed destruction of lobular architecture and extensive centrilobular infiltration of immune cells. Additionally, immunohistochemical staining revealed CD8+ T cells were in contact with the dying hepatocytes and many CD56+ cells infiltrated into the site of inflammation. Multicolor fluorescence activated cell-sorting analysis showed numerous intrahepatic CD8+T cells present within her. In accordance with the investigations, nilotinib induced liver injury was diagnosed. Treatment with prednisolone was initiated and her liver enzyme decreased to the normal level. Thereafter, treatment with prednisolone was tapered and discontinued after 14 days. Following treatment discontinuation, her liver enzyme were within the normal range. Yang H, et al. Nilotinib-Induced Immune-Mediated Liver Injury: Corticosteroid as a Possible Therapeutic Option. Frontiers in Oncology 10: 1160, 10 Jul 2020. Available 803497361 from: URL: http://doi.org/10.3389/fonc.2020.01160
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Reactions 22 Aug 2020 No. 1818
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