Management of life-threatening pulmonary leukostasis with single agent imatinib mesylate during CML myeloid blast crisis.
Pulmonary leukostasis is a rare but serious and often fatal complication of chronic myeloid leukemia (CML) in blast crisis and acute myeloid leukemia. Treatment options are limited for these patients. Imatinib mesylate (STI-571, Gleevec, Novartis) is a potent and selective inhibitor of the BCR-abl tyrosine kinase, the molecular abnormality that causes CML. The case of a 74-year-old man with a history of CML who presented in myeloid blast crisis with pulmonary leukostasis characterized by increasing dyspnea, hypoxemia, fever, and impending respiratory failure is reported. The patient was treated with single agent imatinib mesylate (IM) with rapid decrease in his white blood cell count (WBC) and marked improvement in his respiratory status. No electrolyte abnormalities consistent with tumor lysis syndrome were observed. IM may be an effective single agent therapy for pulmonary leukostasis in patients with CML blast crisis who are at the risk for tumor lysis.
Leis
Jose F
JF
Center for Hematologic Malignancies, Oregon Health & Science University, Portland, OR 97239-3098, USA. leisj@ohsu.edu <leisj@ohsu.edu>
Primack
Steven L
SL
Schubach
Susan E
SE
Curtin
Peter T
PT
Druker
Brian J
BJ
Maziarz
Richard T
RT
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017209:Apoptosis / Q000187:drug effects; D001549:Benzamides; D001752:Blast Crisis / Q000150:complications*; D004417:Dyspnea / Q000209:etiology; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications*; D018921:Leukostasis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D008168:Lung / Q000098:blood supply* / Q000000981:diagnostic imaging; D008297:Male; D010879:Piperazines / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D012074:Remission Induction; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate