CD4+CD8+ lymphocytosis and pleural and pericardiac effusions in a patient with chronic myelogenous leukemia in chronic phase treated with dasatinib due to imatinib failure

Abstract

Using tyrosine kinase inhibitors in chronic myelogenous leukemia (CML) patients may have resulted in abnormalities of the immune system. The paper is showing disease outcome in a patient with CML in chronic phase treated with interpheron a, and thereafter with imatinib (IM) due to loss of major cytogenetic response. After 4 years of IM treatment, despite previous major molecular response (MMR) obtained, loss of complete cytogenetic response was documented (mutational resistance, M244V BCR/ABL1). Administering 100 mg dasatinib daily in consecutive treatment line allowed obtaining deep molecular response (DMR). During initial 9 months of the treatment, tolerance was good. Thereafter, the general symptoms could be observed (subfebrile states, excessive sweets), rhinitis and leukocytosis with absolute lymphocytosis CD3+, CD8+, HLA-DR in the peripheral blood. After two years, due to an increase in symptoms intensity, the dose of the drug was reduced to 80 mg daily. It was related with symptoms release and normalization of leuko- and lymphocyte count in the blood. Drug dose reduction, however, resulted in loss of MMR. Increasing the dose to the initial one allowed re-obtaining DMR. Improvement in molecular response quality was associated with reccurrence of general symptoms and lymphocytosis in the peripheral blood. After a few months, pleural/pericardial effusion symptoms were noted. Patient required hospitalization and therapeutic paracentesis. After normalization of the general patient status, the decision about nilotinib treatment was taken. During 12 months follow-up, the drug tolerance was good. Nilotinib treatment resulted in fast disappearance of general symptoms and lymphocytosis, and achievement of DMR.