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International Journal of Hematology
Published in: International Journal of Hematology 5/2020

01-05-2020 | Acute Lymphoblastic Leukemia | Case Report

Nilotinib treatment induced large granular lymphocyte expansion and maintenance of longitudinal remission in a Philadelphia chromosome-positive acute lymphoblastic leukemia

Authors: Masao Hagihara, Jian Hua, Morihiro Inoue, Tomoyuki Uchida, Shiro Ide, Shin Ohara, Tomoiku Takaku

Published in: International Journal of Hematology | Issue 5/2020

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Abstract

It is well known that the second-generation tyrosine kinase inhibitor dasatinib evokes an immunological reaction as an off-target effect and induces large granular lymphocytes (LGLs) expansion in 30% of patients. However, LGLs expansion in nilotinib-treated patients is rare. We report the case of a 65-year-old patient with Philadelphia chromosome (Ph)-positive acute lymphoblastic leukemia (ALL) who showed LGLs expansion during nilotinib treatment. The patient achieved complete remission (CR) after multi-agent chemotherapy combined with dasatinib treatment. However, ALL relapsed in the central nervous system and bone marrow when treatment was interrupted due to interstitial pneumonia. Nilotinib treatment was subsequently started and the patient achieved second CR. Marked peripheral blood lymphocytosis emerged after the start of nilotinib treatment. CD8 + CD57 + cytotoxic T cells were predominantly expanded and showed strong cytocidal activity against K562 Ph-positive leukemia cells. These results suggest that similar to dasatinib, nilotinib can induce LGLs expansion, possibly contributing to long-term remission in patients with Ph-ALL.
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Metadata
Title
Nilotinib treatment induced large granular lymphocyte expansion and maintenance of longitudinal remission in a Philadelphia chromosome-positive acute lymphoblastic leukemia
Authors
Masao Hagihara
Jian Hua
Morihiro Inoue
Tomoyuki Uchida
Shiro Ide
Shin Ohara
Tomoiku Takaku
Publication date
01-05-2020
Publisher
Springer Singapore
Published in
International Journal of Hematology / Issue 5/2020
Print ISSN: 0925-5710
Electronic ISSN: 1865-3774
DOI
https://doi.org/10.1007/s12185-019-02789-6

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