Article PDF first page preview

Article PDF first page preview

Lifelong immunosuppression, cytotoxic effects of some immunosuppressive drugs, and opportunistic oncogenic viruses increase malignancy risks in solid organ recipients. The risk of myeloid neoplasms including chronic myeloid leukemia (CML) is also increased in this patient population. Tyrosine kinase inhibitors (TKIs), the key element of CML therapy, should be used cautiously in transplantation patients as they may interact with calcineurin inhibitors. With this report, a 63-year-old female kidney transplant recipient who developed CML 9 years after kidney transplantation is presented. CML in this patient was treated with a slightly reduced dose of imatinib (300 mg) due to concerns of adverse events including its interaction with tacrolimus. Deep molecular response (DMR) was achieved at 12 months under imatinib treatment. The patient is still in DMR after 30 months of follow-up, and she did not experience any adverse events or acute rejection episodes. CML and the use of TKIs in kidney transplant patients have been discussed with an extensive literature review. In this patient population, TKIs are generally well tolerated with achievement of treatment responses and good prognosis. Graft functions are also well maintained as long as drug interactions are monitored.

1.
Engels
EA
,
Pfeiffer
RM
,
Fraumeni
JF
,
Kasiske
BL
,
Israni
AK
,
Snyder
JJ
, et al
.
Spectrum of cancer risk among US solid organ transplant recipients
.
JAMA
.
2011
;
306
(
17
):
1891
901
.
2.
Grulich
AE
,
van Leeuwen
MT
,
Falster
MO
,
Vajdic
CM
.
Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis
.
Lancet
.
2007
;
370
(
9581
):
59
67
.
3.
Wang
Y
,
Lan
GB
,
Peng
FH
,
Xie
XB
.
Cancer risks in recipients of renal transplants: a meta-analysis of cohort studies
.
Oncotarget
.
2018
;
9
(
20
):
15375
85
.
4.
Krynitz
B
,
Edgren
G
,
Lindelöf
B
,
Baecklund
E
,
Brattström
C
,
Wilczek
H
, et al
.
Risk of skin cancer and other malignancies in kidney, liver, heart and lung transplant recipients 1970 to 2008: a Swedish population-based study
.
Int J Cancer
.
2013
;
132
(
6
):
1429
38
.
5.
Morton
LM
,
Gibson
TM
,
Clarke
CA
,
Lynch
CF
,
Anderson
LA
,
Pfeiffer
R
, et al
.
Risk of myeloid neoplasms after solid organ transplantation
.
Leukemia
.
2014
;
28
(
12
):
2317
23
.
6.
Osman
AEG
,
Deininger
MW
.
Chronic Myeloid Leukemia: modern therapies, current challenges and future directions
.
Blood Rev
.
2021
;
49
:
100825
.
7.
Sönmez
Ö
,
Özgür Yurttaş
N
,
İhtiyaroğlu
İ
,
Çakır
HM
,
Atlı
Z
,
Elverdi
T
, et al
.
Effect of tyrosine kinase inhibitor therapy on estimated glomerular filtration rate in patients with chronic myeloid leukemia
.
Clin Lymphoma Myeloma Leuk
.
2024
;
24
(
4
):
232
9
.
8.
Haouala
A
,
Widmer
N
,
Duchosal
MA
,
Montemurro
M
,
Buclin
T
,
Decosterd
LA
.
Drug interactions with the tyrosine kinase inhibitors imatinib, dasatinib, and nilotinib
.
Blood
.
2011
;
117
(
8
):
e75
87
.
9.
Manickavasagar
R
,
Thuraisingham
R
.
Post renal-transplant malignancy surveillance
.
Clin Med
.
2020
;
20
(
2
):
142
5
.
10.
Tendulkar
KK
,
Cope
B
,
Dong
J
,
Plumb
TJ
,
Campbell
WS
,
Ganti
AK
.
Risk of malignancy in patients with chronic kidney disease
.
PLos One
.
2022
;
17
(
8
):
e0272910
.
11.
Leone
G
,
Fianchi
L
,
Pagano
L
,
Voso
MT
.
Incidence and susceptibility to therapy-related myeloid neoplasms
.
Chem Biol Interact
.
2010
;
184
(
1–2
):
39
45
.
12.
Karran
P
,
Attard
N
.
Thiopurines in current medical practice: molecular mechanisms and contributions to therapy-related cancer
.
Nat Rev Cancer
.
2008
;
8
(
1
):
24
36
.
13.
Gallagher
MP
,
Kelly
PJ
,
Jardine
M
,
Perkovic
V
,
Cass
A
,
Craig
JC
, et al
.
Long term cancer risk of immunosuppressive regimens after kidney transplantation
.
J Am Soc Nephrol
.
2010
;
21
(
5
):
852
8
.
14.
Mossmann
D
,
Park
S
,
Hall
MN
.
mTOR signalling and cellular metabolism are mutual determinants in cancer
.
Nat Rev Cancer
.
2018
;
18
(
12
):
744
57
.
15.
Wu
B
,
Ingersoll
K
,
Jug
R
,
Yang
LH
,
Luedke
C
,
Lo
A
, et al
.
Myeloid neoplasms following solid organ transplantation: clinicopathologic studies of 23 cases
.
Am J Clin Pathol
.
2017
;
149
(
1
):
55
66
.
16.
Oberender
C
,
Kleeberg
L
,
Nienhues
N
,
Gresse
M
,
Dörken
B
,
Riess
H
, et al
.
Clinical lessons to be learned from patients developing chronic myeloid leukemia while on immunosuppressive therapy after solid organ transplantation: yet another case after orthotopic heart transplantation
.
Case Rep Hematol
.
2014
;
2014
:
890438
.
17.
le Coutre
P
,
Reinke
P
,
Neuhaus
R
,
Trappe
R
,
Ringel
F
,
Lalancette
M
, et al
.
BCR-ABL positive cells and chronic myeloid leukemia in immune suppressed organ transplant recipients
.
Eur J Hem
.
2010
;
84
(
1
):
26
33
.
18.
Dhanarajan
A
,
Hsu
JW
,
le Coutre
P
,
Wingard
JR
,
Chang
M
,
Norkin
M
.
Elevated incidence of chronic myeloid leukemia in immunosuppressed solid organ transplant recipients
.
Br J Hematol
.
2014
;
166
:
612
28
.
19.
Amitai
I
,
Abulafia
AS
,
Raanani
P
,
Lipton
JH
.
Chronic myeloid leukemia in solid organ transplant patients: a case series
.
Int J Hematol
.
2021
;
113
(
2
):
214
8
.
20.
Castillo-Rama
M
,
Grande
C
,
Martinez-Sanchez
P
,
Olavarria
E
,
Marin
D
,
Paz-Artal
E
, et al
.
Molecular remission of chronic myeloid leukemia in a patient with hepatitis and a second kidney transplant
.
Nefrologia
.
2009
;
29
(
6
):
604
7
.
21.
Pelloso
LA
,
Campos
MG
,
Nascimento
M
,
Silva
MR
,
Pestana
JO
,
Chauffaille
MD LLF
.
Chronic Myeloid Leukemia following kidney transplantation
.
Leuk Res
.
2005
;
29
(
3
):
353
5
.
22.
Yamane
H
,
Ide
K
,
Tanaka
A
,
Hashimoto
S
,
Nagoshi
H
,
Tahara
H
, et al
.
Successful treatment of chronic myeloid leukemia with dasatinib after kidney transplantation: a case report
.
Transplant Proc
.
2020
;
52
(
2
):
600
3
.
23.
Sayar
H
,
Sharfuddin
AA
,
Taber
TE
,
Mehta
R
.
Chronic myeloid leukemia within a year of kidney transplant with elevated alkaline phosphatase correlated with imatinib therapy
.
Exp Clin Transplant
.
2011
;
9
:
336
9
.
24.
Thierry
A
,
Dreyfus
B
,
Bridoux
F
,
Abou Ayache
R
,
Milin
S
,
Guilhot
F
, et al
.
Long-term molecular efficacy and safety of imatinib in a patient with chronic myeloid leukemia after renal transplantation
.
NDT
.
2007
;
22
:
1792
.
25.
Fontana
V
,
Dudkiewicz
P
,
Horstman
LL
,
Tzakis
AG
,
Ahn
YS
.
Atypical chronic myeloid leukemia following organ transplants
.
Clin Transplant
.
2008
;
22
(
2
):
258
61
.
26.
Oskuei
A
,
Makhdoomi
K
,
Abkhiz
S
,
Vossoghian
S
,
Farrokhpour
M
.
Successful treatment of Chronic Myelogenic Leukemia (CML) with imatinib after renal transplantation
.
Arch Iran Med
.
2014
;
17
(
5
):
388
90
.
27.
Uchida
Y
,
Koyama
D
,
Manabe
K
,
Suzuki
K
,
Asano
N
,
Endo
M
, et al
.
High efficacy and safety of asciminib in a chronic myeloid leukemia patient with chronic kidney disease following renal transplantation: a case report
.
Intern Med
.
2023
;
5
.
28.
Miyoshi
I
,
Mori
M
,
Yamasaki
I
,
Daibata
M
.
Is there an entity of radiation-induced chronic myeloid leukemia? Report of a case and brief review of the literature
.
J Clin Exp Hematop
.
2020
;
60
(
1
):
24
5
.
29.
Teo
YL
,
Ho
HK
,
Chan
A
.
Metabolism-related pharmacokinetic drug-drug interactions with tyrosine kinase inhibitors: current understanding, challenges and recommendations
.
Br J Clin Pharmacol
.
2015
;
79
(
2
):
241
53
.
30.
Hughes
A
,
Clarson
J
,
Tang
C
,
Vidovic
L
,
White
DL
,
Hughes
TP
, et al
.
CML patients with deep molecular responses to TKI have restored immune effectors and decreased PD-1 and immune suppressors
.
Blood
.
2017
;
129
(
9
):
1166
76
.
31.
Savikko
J
,
Taskinen
E
,
Von Willebrand
E
.
Chronic allograft nephropathy is prevented by inhibition of platelet-derived growth factor receptor: tyrosine kinase inhibitors as a potential therapy
.
Transplantation
.
2003
;
75
(
8
):
1147
53
.
32.
Thiem
U
,
Buxhofer-Ausch
V
,
Kranewitter
W
,
Webersinke
G
,
Enkner
W
,
Cejka
D
.
Successful kidney transplantation in a patient with pre-existing chronic myeloid leukemia treated with imatinib
.
Am J Transplant
.
2021
;
21
(
1
):
405
9
.
33.
Posthuma
EF
,
Falkenburg
JH
,
Apperley
JF
,
Gratwohl
A
,
Roosnek
E
,
Hertenstein
B
, et al
.
HLA-B8 and HLA-A3 coexpressed with HLA-B8 are associated with a reduced risk of the development of chronic myeloid leukemia. The Chronic Leukemia Working Party of the EBMT
.
Chronic Leuk Working Party EBMT Blood
.
1999
;
93
(
11
):
3863
5
.
You do not currently have access to this content.