Contributions
Abstract: PB1533
Type: Publication Only
Session title: Chronic myeloid leukemia - Clinical
Background
Discovery of tyrosine Kinase inhibitors (TKIs) was a watershed moment in Chronic Myeloid Leukemia (CML) treatment. Adverse cutaneous reactions (ACRs) represent the most common non-hematological adverse reactions with TKIs. More with 1st generation TKIs (Imatinib), tend to be less severe with second-generation. Development of psoriasis during Imatinib and Nilotinib was reported in few cases. One reported case showed that Dasatinib causing worsening of Psoriasis vulgaris. To our knowledge, this is the first case showed complete remission of psoriasis after Treatment with Dasatinib.
Aims
To document a rare beneficial effect of dasatinib which is accidently discovered during treating female patient of CML.
Methods
Case Report: 27 years old Saudi Female, medically free before, presented in Jul 2019 to ED with abdominal pain mainly in epigastric region associated with heart burn and vomiting, this condition started 3 days ago. Preceded by fever mainly during night, night sweating and weight loss for 1 month. She also suffered from recurrent nose bleeds with headache. Clinical examination showed Huge splenomegaly reaching Umbilicus. Skin examination showed multiple ecchymotic patches with multiple skin lesions scattered all over the abdomen, back and lower limbs which were red in Colour with scaly patches.
Initial laboratory tests showed anemia (Hb 7.8 gm/dL), leukocytosis (WBC 537.00 x 109/L), with platelet count 327.00 x 109/L. The Peripheral blood smear showed picture of Chronic Myeloid Leukemia –chronic phase. The pelvi-abdominal ultrasound showed markedly enlarged splenomegaly 20 cm in size. Coagulation profile was with normal range. High LDH level [820 U/L]. ESR 1st hour was 100. PCR was positive for the BCR-ABL1 fusion transcript p210(85% IS score). July 2019 Back skin, Punch biopsy showed hyperkeratosis, parakeratosis, Munro's micro abscess, acanthosis, diminished granular layer, and tortuous dilated papillary capillaries which Consistent with annular non-pustular psoriasis.
Sockal score was calculated to be Intermediate. She had plan for marriage after 1 year from diagnosis. So, we started Dasatinib 100 mg once daily with optimum response at 3 months (BCR-ABL 1% IS score). But the amazing thing is that psoriatic lesions started to improve gradually without using any medications for psoriasis. During her last visit to Hematology Clinic on Feb 2021, she was very happy that psoriasis disappeared completely and got married with gentleman accompanied her to the clinic. She agreed to take photos for abdomen and Lower Limb.
Results
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Conclusion
It is well known that tyrosine kinase inhibitors made a revolution in CML, but it can be hope for other difficult treating conditions as psoriasis.
Keyword(s): Chronic myeloid leukemia, Tyrosine kinase inhibitor
Abstract: PB1533
Type: Publication Only
Session title: Chronic myeloid leukemia - Clinical
Background
Discovery of tyrosine Kinase inhibitors (TKIs) was a watershed moment in Chronic Myeloid Leukemia (CML) treatment. Adverse cutaneous reactions (ACRs) represent the most common non-hematological adverse reactions with TKIs. More with 1st generation TKIs (Imatinib), tend to be less severe with second-generation. Development of psoriasis during Imatinib and Nilotinib was reported in few cases. One reported case showed that Dasatinib causing worsening of Psoriasis vulgaris. To our knowledge, this is the first case showed complete remission of psoriasis after Treatment with Dasatinib.
Aims
To document a rare beneficial effect of dasatinib which is accidently discovered during treating female patient of CML.
Methods
Case Report: 27 years old Saudi Female, medically free before, presented in Jul 2019 to ED with abdominal pain mainly in epigastric region associated with heart burn and vomiting, this condition started 3 days ago. Preceded by fever mainly during night, night sweating and weight loss for 1 month. She also suffered from recurrent nose bleeds with headache. Clinical examination showed Huge splenomegaly reaching Umbilicus. Skin examination showed multiple ecchymotic patches with multiple skin lesions scattered all over the abdomen, back and lower limbs which were red in Colour with scaly patches.
Initial laboratory tests showed anemia (Hb 7.8 gm/dL), leukocytosis (WBC 537.00 x 109/L), with platelet count 327.00 x 109/L. The Peripheral blood smear showed picture of Chronic Myeloid Leukemia –chronic phase. The pelvi-abdominal ultrasound showed markedly enlarged splenomegaly 20 cm in size. Coagulation profile was with normal range. High LDH level [820 U/L]. ESR 1st hour was 100. PCR was positive for the BCR-ABL1 fusion transcript p210(85% IS score). July 2019 Back skin, Punch biopsy showed hyperkeratosis, parakeratosis, Munro's micro abscess, acanthosis, diminished granular layer, and tortuous dilated papillary capillaries which Consistent with annular non-pustular psoriasis.
Sockal score was calculated to be Intermediate. She had plan for marriage after 1 year from diagnosis. So, we started Dasatinib 100 mg once daily with optimum response at 3 months (BCR-ABL 1% IS score). But the amazing thing is that psoriatic lesions started to improve gradually without using any medications for psoriasis. During her last visit to Hematology Clinic on Feb 2021, she was very happy that psoriasis disappeared completely and got married with gentleman accompanied her to the clinic. She agreed to take photos for abdomen and Lower Limb.
Results
-
Conclusion
It is well known that tyrosine kinase inhibitors made a revolution in CML, but it can be hope for other difficult treating conditions as psoriasis.
Keyword(s): Chronic myeloid leukemia, Tyrosine kinase inhibitor