Tuberc Respir Dis.  2013 Dec;75(6):256-259.

Successful Rechallenge with Imatinib in a Patient with Chronic Myeloid Leukemia Who Previously Experienced Imatinib Mesylate Induced Pneumonitis

• Go SW
• Kim BK
• Lee SH
• Kim TJ
• Huh JY
• Lee JM
• Hah JH
• Kim DW
• Cho MJ
• Kim TW
• Kang JY

Abstract

Imatinib mesylate is a targeted therapy that acts by inhibiting tyrosine kinase of the bcr-abl fusion oncoprotein, which is specific to chronic myeloid leukemia (CML), and the c-transmembrane receptor, which is specific to gastrointestinal stromal tumors. Interstitial pneumonitis is a rare adverse event of imatinib therapy. It is clinically difficult to distinguish from infectious pneumonia, which can frequently occur due to the underlying disease. The standard treatment for imatinib-induced pneumonitis is to discontinue the medication and optionally administer corticosteroids. However, there are a few cases of successful retrial with imatinib. We describe a case of successful rechallenge of imatinib in a patient with imatinib-induced interstitial pneumonitis and CML without a recurrence of the underlying disease after 3 months of follow-up.

Keyword

Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Imatinib; Lung Diseases, Interstitial

MeSH Terms

Adrenal Cortex Hormones
Follow-Up Studies
Gastrointestinal Stromal Tumors
Humans
Leukemia, Myelogenous, Chronic, BCR-ABL Positive*
Lung Diseases, Interstitial
Mesylates*
Pneumonia*
Protein-Tyrosine Kinases
Recurrence
Imatinib Mesylate
Adrenal Cortex Hormones
Mesylates
Protein-Tyrosine Kinases

Figure

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  Figure 1 Chest X-ray shows bilateral reticulonodular infiltration in both lungs at admission (A) and slight regression of peribronchial patchy opacities in both lungs at 2 weeks after discontinuing imatinib and commencing steroid treatment (B).

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  Figure 2 Chest high resolution computed tomography scan reveals patchy ground glass opacities with some interlobar and intralobular septal thickening in both lungs, predominantly seen in the central and upper lung zones (A), and interval improvement of the interstitial pneumonia with some remaining ground glass opacity after 12 weeks of rechallenge with imatinib (B).

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  Figure 3 (A, B) Transbronchial lung biopsy specimen reveals organizing pattern of interstitial pneumonia, showing fibroblastic plug formation in the alveoli with infiltration of chronic inflammatory cells and mild fibrous thickening in the interstitium (H&E stain; A, ×40; B, ×200).

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