title: [Peripheral artery occlusive disease of the lower limbs: Rapid aggravation in a patient taking nilotinib for chronic myeloid leukemia].
abstract: The development of tyrosine kinase inhibitors (TKI) has revolutionized management of patients with chronic myeloid leukemia (CML), transforming this fatal disease into a chronic disease with nearly normal life expectancy. Nilotinib is a second generation TKI targeting the oncoprotein BCR-ABL used in patients in the chronic phase of CML. Several research teams have suggested over recent years that nilotinib might be the causal agent in the development or aggravation of vascular disease, particularly in patients with cardiovascular risk factors or an established cardiovascular disease. We report here the case of a patient who developed severe peripheral arterial disease of the lower limbs that worsened despite optimal medical and surgical care, presenting recurrent re-stenoses after different revascularization techniques (bypass, angioplasty…) associated with aggravation of severe trophic disorders to the point of potentially requiring amputation. Discontinuation of nilotinib enabled a stabilization of the arterial lesions and complete healing of the trophic lesions. This case illustrates the importance of recognizing co-morbid conditions in patients with severe vascular disease and to examine the possibility of drug interactions leading to rapid aggravation of arterial disease with no other cause. Studying the pathophysiological impact of TKIs on the vascular system may open new avenues of research for the investigation of factors triggering arteriosclerosis.
authors.affiliation: Inserm U970, pôle cardiovasculaire, service de médecine vasculaire, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: Gautier
authors.affiliation: Inserm U970, pôle cardiovasculaire, service de médecine vasculaire, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Mirault
authors.affiliation: Radiologie cardiovasculaire, pôle cardiovasculaire, université Paris Descartes, hôpital européen Georges-Pompidou, 75015 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Azarine
authors.affiliation: Inserm U970, pôle cardiovasculaire, service de chirurgie vasculaire, université Paris Descartes, hôpital européen Georges-Pompidou, 75015 Paris, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Alsac
authors.affiliation: Radiologie cardiovasculaire, pôle cardiovasculaire, université Paris Descartes, hôpital européen Georges-Pompidou, 75015 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Sapoval
authors.affiliation: Service d'hématologie, hôpital Saint-Louis, 75015 Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Réa
authors.affiliation: Inserm U970, pôle cardiovasculaire, service de médecine vasculaire, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France. Electronic address: emmanuel.messas@egp.aphp.fr.
authors.forename: E
authors.initials: E
authors.lastname: Messas
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000139:chemically induced / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D018450:Disease Progression; D050171:Dyslipidemias / Q000150:complications; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D007871:Leg Ulcer / Q000209:etiology / Q000601:surgery; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000139:chemically induced / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D047428:Protein Kinase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D011859:Radiography; D012008:Recurrence; D012907:Smoking / Q000009:adverse effects; D014656:Vascular Surgical Procedures
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; C498826:nilotinib
keywords: Artériopathie; Chronic myeloid leukemia; Leucémie myéloïde chronique; Nilotinib; Peripheral artery occlusive disease