TNF-alpha inhibitor etanercept and hematologic malignancies: report of a case and review of the literature.
We report here a 57-year-old man treated with etanercept for 6 months for psoriasis who developed myelodysplasia with acute myeloid leukemia. Leukemia cells had distinct karyotype associated with poor prognosis. The patient did not respond to cytosine arabinoside 100 mg/m(2) continuous infusion over 7 days with daunorubicin 45 mg/m(2) daily for 3 days. He also did not respond to salvage induction therapy with gemtuzumab (6 mg/m(2) on day 1 and 4 mg/m(2) on day 8) and intravenous continuous infusion cytosine arabinoside 200 mg/m(2). We review other cases of lymphoma and leukemia associated with tumor necrosis factor inhibitors and suggest mechanisms by which inhibition of the TNF-alpha family may predispose to cancer. We also suggest that all patients being considered for TNF-alpha treatment be screened for hematologic malignancies or premalignancies with blood counts and bone marrow aspirates/biopsies if indicated.
Nair
Bijay
B
Division of Hematology/Oncology, Department of Internal Medicine, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas 72205, USA.
Raval
Girindra
G
Mehta
Paulette
P
D015535:Arthritis, Psoriatic / Q000188:drug therapy; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects*; D015470:Leukemia, Myeloid, Acute / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000139:chemically induced; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept