Persistência do uso de nilotinibe frente ao acometimento sistêmico no tratamento da Leucemia Mieloide Crônica: Um relato de caso

• Autor(a) principal: Henrique, Francisco Victor Cavalcante de Andrade
• Data de Publicação: 2020
• Tipo de documento: Trabalho de conclusão de curso
• Idioma: por
• Título da fonte: Repositório do Centro Universitário Braz Cubas
• Texto Completo: https://repositorio.cruzeirodosul.edu.br/handle/123456789/1371
• topic: Leucemia mielóide; Nilotinibe; CNPQ::CIÊNCIAS DA SAÚDE::MEDICINA

Chronic myeloid leukemia (CML) is a rare myeloproliferative neoplasm associated with a specific cytogenetic abnormality known as the Philadelphia chromosome. The advent of tyrosine kinase inhibitors (ITK) revolutionized the treatment of these patients in achieving durable cytogenetic and molecular remissions and substantially improved survival in most patients. Nilotinib is a second-generation ITK composing the second line of treatment of the condition. However, there is still little information in the literature on the management of the toxicity of these drugs, and therefore, when evaluating the options of ITK in the therapy of patients with CML, it is necessary to consider several clinically relevant outcomes. This project aimed to report the persistence of the use of nilotinib in the face of systemic manifestations related to its use in a patient with CML. This is a descriptive and qualitative case report, carried out through the consultation of data from the medical records of a patient in the outpatient clinic of a hematology service in João Pessoa (PB). The study was characterized by a 51-year-old asymptomatic man who was referred to the hematology outpatient clinic for evaluation of persistent leukocytosis. In January 2016, the results confirmed the diagnosis of CML, chronic phase, initiating use of Imatinib. After 3 months, there was a suboptimal response and the exchange for Nilotinib was decided. In 30 days, diffuse erythematous lesions appeared on plaques and pruriginous, mainly in trunks and upper limbs, which regressed after the use of prednisone and returned after discontinuation of it. In December 2017, the patient presented fever, leukocytosis, elevation of inflammatory markers and recrudescence of skin lesions. A transthoracic echocardiogram suggested mitral valve vegetation, and after antibiotic therapy for 6 weeks and reintroduction of corticosteroids, already asymptomatic, the same examination indicated inalteration of the valve lesion. Subsequently, a PET-CT ruled out inflammatory or infectious activity in the valve, and it was decided to keep the ITK in association with prednisone on alternate days, and the patient remained asymptomatic, following clinical and laboratory follow-up every 3 months. That said, it was possible to conclude that, given the toxicity found by the use of nilotinib, the continuity of the drug with association with oral corticosteroids improved the effects of systemic inflammatory activity presented by the patient during therapy. Therefore, the benefit of ITK has outweighed the risks of its withdrawal in the case in question and should be assessed individually.