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[Refractory acute monocytic leukemia with cutaneous infiltration complicated by sterile pustules after CPX-351
Takahiro Nishiyama1, Takuya Maki2, Tomohiro Yamada1
1Department of Hematology, Ichinomiya Municipal Hospital.
Abstract:
CPX-351 (Vyxeos®), a liposomal formulation used in the treatment of acute myeloid leukemia, has been associated with cutaneous adverse events, particularly purpura, in previous clinical trials. We present the case of a 73-year-old woman with refractory acute monocytic leukemia and leukemia cutis, who was treated with CPX-351 as salvage induction therapy. Following treatment, the extramedullary lesions resolved; however, some skin lesions developed into pustular eruptions. These pustules appeared during the neutropenic phase, and cultures ruled out infection, leading to the diagnosis of sterile pustulosis. Supportive care, including skin care measures and application of antibiotic ointment, allowed for continued treatment, and the pustules resolved after crusting. To our knowledge, this is the first reported case of sterile pustulosis associated with CPX-351 treatment, highlighting the importance of early detection and appropriate management of skin complications for the successful continuation of therapy.
Insights
CPX-351 (Vyxeos) treatment for acute myeloid leukemia can cause skin issues. This case report details a patient who developed sterile pustulosis, a non-infectious skin reaction, during neutropenia, which was successfully managed to allow continued therapy.
Area of Science:
- Hematology
- Oncology
- Dermatology
Background:
- CPX-351 (Vyxeos) is a liposomal formulation for acute myeloid leukemia (AML).
- Previous studies noted cutaneous adverse events, like purpura, with CPX-351.
- Leukemia cutis can occur in patients with acute monocytic leukemia.
Purpose of the Study:
- To report the first case of sterile pustulosis associated with CPX-351 treatment.
- To highlight the management of skin complications during CPX-351 therapy.
Main Methods:
- A case study of a 73-year-old woman with refractory acute monocytic leukemia and leukemia cutis.
- Treatment with CPX-351 as salvage induction therapy.
- Monitoring of skin lesions, including pustular eruptions during neutropenia, with diagnostic cultures and supportive care.
Main Results:
- Extramedullary lesions resolved after CPX-351 treatment.
- Patient developed sterile pustulosis during the neutropenic phase, confirmed by negative cultures.
- Supportive care enabled continued CPX-351 treatment, and pustules resolved after crusting.
Conclusions:
- Sterile pustulosis is a potential, non-infectious skin complication of CPX-351 therapy.
- Early detection and management of skin issues are crucial for successful AML treatment continuation.
- This case underscores the need for vigilance regarding dermatologic adverse events in CPX-351 treated patients.
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