Hypertension and Life-Threatening Bleeding in Children with Relapsed Acute Myeloblastic Leukemia Treated with FLT3 Inhibitors.
Experiences with new multikinase inhibitors are limited, especially in children. In this report we summarize our experience with 2 patients with relapsed acute myeloblastic leukemia (AML), one with FMS-like tyrosine kinase-3-internal tandem duplication mutation and the other with a single base mutation (D835Y). Both patients received sorafenib, one for 19 days and the other for 42 days, with clofarabine-including chemotherapy. One additionally received sunitinib for a total of 20 days. Both patients developed severe pancytopenia, hypertension, life-threatening bleedings from the gastrointestinal system, and, finally, intrapulmonary hemorrhage. Although both reached severe aplasia of the bone marrow without blastic infiltration, death occurred with neutropenic sepsis.
Ege University Faculty of Medicine, Department of Pediatric Hematology, İzmir, Turkey Phone: +90 232 390 11 13 E-mail: dyilmazk@yahoo.com.
Deniz
D
Yılmaz Karapınar
Nihal
N
Karadaş
Zühal
Z
Önder Siviş
Can
C
Balkan
Kaan
K
Kavaklı
Yeşim
Y
Aydınok
D000138:Acidosis / Q000139:chemically induced; D058186:Acute Kidney Injury / Q000139:chemically induced; D000227:Adenine Nucleotides / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001087:Arabinonucleosides / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D000077866:Clofarabine; D003561:Cytarabine / Q000008:administration & dosage; D017809:Fatal Outcome; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced*; D007211:Indoles / Q000008:administration & dosage / Q000009:adverse effects*; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000188:drug therapy* / Q000201:enzymology; D008297:Male; D009363:Neoplasm Proteins / Q000037:antagonists & inhibitors*; D009536:Niacinamide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D010146:Pain / Q000139:chemically induced; D010198:Pancytopenia / Q000139:chemically induced; D010671:Phenylurea Compounds / Q000008:administration & dosage / Q000009:adverse effects*; D011480:Protease Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011758:Pyrroles / Q000008:administration & dosage / Q000009:adverse effects*; D016879:Salvage Therapy / Q000009:adverse effects; D018805:Sepsis / Q000209:etiology; D000077157:Sorafenib; D000077210:Sunitinib; D051941:fms-Like Tyrosine Kinase 3 / Q000037:antagonists & inhibitors*
D000227:Adenine Nucleotides; D001087:Arabinonucleosides; D007211:Indoles; D009363:Neoplasm Proteins; D010671:Phenylurea Compounds; D011480:Protease Inhibitors; D011758:Pyrroles; D003561:Cytarabine; D009536:Niacinamide; D000077866:Clofarabine; D000077157:Sorafenib; C497970:FLT3 protein, human; D051941:fms-Like Tyrosine Kinase 3; D000077210:Sunitinib