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Imatinib-induced retroperitoneal fibrosis in a child with chronic myeloid leukemia: a case report
Swaminathan Keerthivasagam1, Nirmalya Roy Moulik1, Ankita Pandey1
1Tata Memorial Centre, Homi Bhaba National Instituite Mumbai, India.
Insights
Retroperitoneal fibrosis (RPF) is a rare complication of imatinib therapy in chronic myeloid leukemia (CML) patients. This case highlights RPF development in a pediatric CML patient on imatinib, requiring intervention but manageable with treatment adjustments.
Area of Science:
- Oncology
- Nephrology
- Pharmacology
Background:
- Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm.
- Imatinib is a tyrosine kinase inhibitor used for CML treatment.
- Retroperitoneal fibrosis (RPF) is a rare but serious condition.
Observation:
- A 12-year-old boy with CML developed bilateral pitting pedal edema and abdominal distension after 41 months of imatinib.
- Imaging and biopsy confirmed retroperitoneal fibrosis (RPF) causing bilateral hydroureteronephrosis.
- The patient required double-J stenting for the right ureter.
Findings:
- Imatinib therapy was briefly interrupted and later resumed, with subsequent substitution by dasatinib.
- The patient remained asymptomatic 18 months after double-J stenting.
- This represents the second reported case of RPF as an imatinib complication in the literature.
Implications:
- This case underscores the importance of monitoring for rare complications like RPF in pediatric CML patients on imatinib.
- Prompt diagnosis and management, including potential drug substitution, are crucial for favorable outcomes.
- Further research may elucidate the mechanisms and risk factors for imatinib-induced RPF.
Abstract:
A 12 year old boy with chronic myeloid leukemia (CML) presenting with bilateral pitting pedal edema and abdominal distension after about 41 months of imatinib therapy and was diagnosed to have retroperitoneal fibrosis (RPF) based on imaging and biopsy findings. He was found to have bilateral hydroureteronephrosis needing double-J stenting to the more severely affected right ureter. Imatinib was briefly interrupted and restarted later due to rising transcript levels and unavailability of other alternatives at that time which was later substituted by dasatinib once generic versions became available. Child remains asymptomatic after 18 months of DJ stenting. RPF is a rare complication of imatinib this being the second case reported in the literature.
