title: First case of immune-mediated haemolytic anaemia associated to imatinib mesylate.
abstract: Imatinib mesylate is a specific inhibitor of protein tyrosine kinase activity secondary to bcr-abl, mostly indicated for the treatment of patients with Philadelphia chromosome positive chronic myeloid leukaemia (CML). Generally, the undesirable effects of imatinib administration observed in clinical trials were of mild-to-moderate degree, and no haemolysis has been associated with this drug. We report here a case of immune-mediated haemolytic anaemia associated to imatinib mesylate successfully treated with prednisone in a patient with CML. Laboratory investigation showed anaemia [haemoglobin (Hb) of 59 g/L], reticulocyte of 61 x 10(9)/L and a positive direct antiglobulin test. Anti-drug in vitro studies revealed a positive result with gel microcolumn assay by an adsorption mechanism. Seventy-four days after prednisone therapy, the patient's Hb level was of 110 g/L with negative direct antiglobulin test and drug in vitro studies. This case demonstrated that patients treated with imatinib mesylate can present immune-mediated haemolysis and adequate management of this event can be done maintaining the drug and associating corticosteroids.
authors.affiliation: Haematology Department, University of São Paulo School of Medicine, São Paulo, Brazil. marcitabrz@yahoo.com
authors.forename: Marcia C Zago
authors.initials: MC
authors.lastname: Novaretti
authors.forename: Guilherme H H
authors.initials: GH
authors.lastname: Fonseca
authors.forename: Mônika
authors.initials: M
authors.lastname: Conchon
authors.forename: Pedro Enrique
authors.initials: PE
authors.lastname: Dorlhiac-Llacer
authors.forename: Dalton de Alencar Fischer
authors.initials: Dde A
authors.lastname: Chamone
mesh_terms: D000743:Anemia, Hemolytic / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology*; D001549:Benzamides; D003298:Coombs Test; D016044:Fusion Proteins, bcr-abl / Q000032:analysis; D006801:Humans; D000068877:Imatinib Mesylate; D054438:Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative / Q000188:drug therapy; D015466:Leukemia, Myeloid, Chronic-Phase / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000009:adverse effects*; D011241:Prednisone / Q000627:therapeutic use; D011743:Pyrimidines / Q000009:adverse effects*
chemical_list: D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate; D016044:Fusion Proteins, bcr-abl; D011241:Prednisone