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Cytomegalovirus-induced Hemorrhagic Colitis in a Patient with Chronic Myeloid Leukemia (Chronic Phase) on Dasatinib as an Upfront Therapy.

Yassin MA, Nashwan AJ, Soliman AT, Yousif A, Moustafa A, AlBattah A, Mohamed SF, Mudawi DS, Elkourashy S, Asaari DR, Gutierrez HL, Almusharaf M, Hussein RM, Moustafa AH, Derhoubi HE, Boukhris S, Kohla S, AlDewik N - Clin Med Insights Case Rep (2015)

Bottom Line: Dasatinib is a kinase inhibitor indicated for the treatment of newly diagnosed adults with Philadelphia chromosome-positive (Ph+) chronic myeloid leukemia (CML) in chronic phase and accelerated (myeloid or lymphoid blast) phase, and CML with resistance or intolerance to prior therapy including imatinib and in adults with Ph+ acute lymphoblastic leukemia1 The most common adverse reactions (≥15%) in patients with newly diagnosed chronic-phase (CP) CML include myelosuppression, fluid retention, and diarrhea, whereas in patients with resistance or intolerance to prior imatinib therapy, side effects include myelosuppression, fluid retention, diarrhea, headache, dyspnea, skin rash, fatigue, nausea, and hemorrhage.We report a 39-year-old Ethiopian female patient who received dasatinib as upfront therapy for the treatment of CP-CML who experienced chronic diarrhea for two months, which progressed to hemorrhagic colitis due to cytomegalovirus (CMV) infection of the colon.To our knowledge, this is the first case of CMV colitis in a patient receiving dasatinib as upfront therapy.

View Article: PubMed Central - PubMed

Affiliation: National Center for Cancer Care and Research, Department of Hematology and BMT, Hamad Medical Corporation, Doha, Qatar.

ABSTRACT
Dasatinib is a kinase inhibitor indicated for the treatment of newly diagnosed adults with Philadelphia chromosome-positive (Ph+) chronic myeloid leukemia (CML) in chronic phase and accelerated (myeloid or lymphoid blast) phase, and CML with resistance or intolerance to prior therapy including imatinib and in adults with Ph+ acute lymphoblastic leukemia1 The most common adverse reactions (≥15%) in patients with newly diagnosed chronic-phase (CP) CML include myelosuppression, fluid retention, and diarrhea, whereas in patients with resistance or intolerance to prior imatinib therapy, side effects include myelosuppression, fluid retention, diarrhea, headache, dyspnea, skin rash, fatigue, nausea, and hemorrhage. We report a 39-year-old Ethiopian female patient who received dasatinib as upfront therapy for the treatment of CP-CML who experienced chronic diarrhea for two months, which progressed to hemorrhagic colitis due to cytomegalovirus (CMV) infection of the colon. To our knowledge, this is the first case of CMV colitis in a patient receiving dasatinib as upfront therapy.

No MeSH data available.


Related in: MedlinePlus

Colonic liner polypoidal lesion, which consists of multiple polypoidal tan brown soft tissue.
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f1-ccrep-8-2015-077: Colonic liner polypoidal lesion, which consists of multiple polypoidal tan brown soft tissue.

Mentions: A 39-year-old Ethiopian female discovered incidentally to have leukocytosis on routine checkup was referred to the Hematology Clinic at the National Center for Cancer Care and Research where her repeated Complete Blood Count (CBC) and peripheral smears were suggestive of the diagnosis of CML. Her clinical examination was not remarkable, with no hepatosplenomegaly. Bone marrow aspiration as well as cytogenetic studies and BCR/ABL by PCR confirmed the diagnosis of CML in a chronic phase with a low Sokal score. Treatment options were discussed with the patient and both pros and cons for each therapy were explained. The patient opted for dasatinib as upfront therapy, which was started as 100 mg orally once daily and the patient was followed up as per European leukemia net (ELN) guidelines. She achieved CHR, CCyR, and MMR after receiving dasatinib for 30 month. However, during her last clinic visit, she complained of diarrhea, which she described as having been watery for the past 2 months. During the last week, she described bloody diarrhea. The patient was admitted to the hospital for further evaluation and management. Her workup showed normal hemogram and normal serum concentrations of creatinine, urea, hepatic enzymes, and electrolytes on admission. Colonoscopy showed multiple, linear, polypoidal-like lesions all over the colon up to the hepatic flexure. Endoscopic diagnosis revealed a picture of infectious colitis suggestive of CMV, Clostridium difficile, and opportunistic parasitic infections less likely to be leukemic deposits or chronic colitis (Figs. 1–4).


Cytomegalovirus-induced Hemorrhagic Colitis in a Patient with Chronic Myeloid Leukemia (Chronic Phase) on Dasatinib as an Upfront Therapy.

Yassin MA, Nashwan AJ, Soliman AT, Yousif A, Moustafa A, AlBattah A, Mohamed SF, Mudawi DS, Elkourashy S, Asaari DR, Gutierrez HL, Almusharaf M, Hussein RM, Moustafa AH, Derhoubi HE, Boukhris S, Kohla S, AlDewik N - Clin Med Insights Case Rep (2015)

Colonic liner polypoidal lesion, which consists of multiple polypoidal tan brown soft tissue.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4554353&req=5

f1-ccrep-8-2015-077: Colonic liner polypoidal lesion, which consists of multiple polypoidal tan brown soft tissue.
Mentions: A 39-year-old Ethiopian female discovered incidentally to have leukocytosis on routine checkup was referred to the Hematology Clinic at the National Center for Cancer Care and Research where her repeated Complete Blood Count (CBC) and peripheral smears were suggestive of the diagnosis of CML. Her clinical examination was not remarkable, with no hepatosplenomegaly. Bone marrow aspiration as well as cytogenetic studies and BCR/ABL by PCR confirmed the diagnosis of CML in a chronic phase with a low Sokal score. Treatment options were discussed with the patient and both pros and cons for each therapy were explained. The patient opted for dasatinib as upfront therapy, which was started as 100 mg orally once daily and the patient was followed up as per European leukemia net (ELN) guidelines. She achieved CHR, CCyR, and MMR after receiving dasatinib for 30 month. However, during her last clinic visit, she complained of diarrhea, which she described as having been watery for the past 2 months. During the last week, she described bloody diarrhea. The patient was admitted to the hospital for further evaluation and management. Her workup showed normal hemogram and normal serum concentrations of creatinine, urea, hepatic enzymes, and electrolytes on admission. Colonoscopy showed multiple, linear, polypoidal-like lesions all over the colon up to the hepatic flexure. Endoscopic diagnosis revealed a picture of infectious colitis suggestive of CMV, Clostridium difficile, and opportunistic parasitic infections less likely to be leukemic deposits or chronic colitis (Figs. 1–4).

Bottom Line: Dasatinib is a kinase inhibitor indicated for the treatment of newly diagnosed adults with Philadelphia chromosome-positive (Ph+) chronic myeloid leukemia (CML) in chronic phase and accelerated (myeloid or lymphoid blast) phase, and CML with resistance or intolerance to prior therapy including imatinib and in adults with Ph+ acute lymphoblastic leukemia1 The most common adverse reactions (≥15%) in patients with newly diagnosed chronic-phase (CP) CML include myelosuppression, fluid retention, and diarrhea, whereas in patients with resistance or intolerance to prior imatinib therapy, side effects include myelosuppression, fluid retention, diarrhea, headache, dyspnea, skin rash, fatigue, nausea, and hemorrhage.We report a 39-year-old Ethiopian female patient who received dasatinib as upfront therapy for the treatment of CP-CML who experienced chronic diarrhea for two months, which progressed to hemorrhagic colitis due to cytomegalovirus (CMV) infection of the colon.To our knowledge, this is the first case of CMV colitis in a patient receiving dasatinib as upfront therapy.

View Article: PubMed Central - PubMed

Affiliation: National Center for Cancer Care and Research, Department of Hematology and BMT, Hamad Medical Corporation, Doha, Qatar.

ABSTRACT
Dasatinib is a kinase inhibitor indicated for the treatment of newly diagnosed adults with Philadelphia chromosome-positive (Ph+) chronic myeloid leukemia (CML) in chronic phase and accelerated (myeloid or lymphoid blast) phase, and CML with resistance or intolerance to prior therapy including imatinib and in adults with Ph+ acute lymphoblastic leukemia1 The most common adverse reactions (≥15%) in patients with newly diagnosed chronic-phase (CP) CML include myelosuppression, fluid retention, and diarrhea, whereas in patients with resistance or intolerance to prior imatinib therapy, side effects include myelosuppression, fluid retention, diarrhea, headache, dyspnea, skin rash, fatigue, nausea, and hemorrhage. We report a 39-year-old Ethiopian female patient who received dasatinib as upfront therapy for the treatment of CP-CML who experienced chronic diarrhea for two months, which progressed to hemorrhagic colitis due to cytomegalovirus (CMV) infection of the colon. To our knowledge, this is the first case of CMV colitis in a patient receiving dasatinib as upfront therapy.

No MeSH data available.


Related in: MedlinePlus