Life threatening hepatotoxicity induced by Nilotinib.

INTRODUCTION: Tyrosine kinase inhibitor had changed the prognosis of chronic myeloid leukemia (CML) and the overall survival had reached 95%. Unfortunately, adverse events (AEs) remain an obstacle to following successful treatment in CML impairing the quality of life and sometimes endangering the lives of patients. To this end, we show this clinical case to discuss strategies to deal with rare AEs in a way to preserve the patient's life and to maintain not only a good response to treatment but also confidence and compliance of the patient. CASE REPORT: We report the case of a 57-year-old woman diagnosed with CML at the chronic phase who developed rare life-threatening hepatotoxicity (major cytolysis and prothrombin time fall) secondary to Nilotinib used as second-line treatment. This complication settled despite an optimal molecular response. MANAGEMENT AND OUTCOME: We discuss below the follow-up and management in our center and according to the literature with more sophisticated pharmacological methods. DISCUSSION: Although we used to monitor disease molecular response to treatment, we need solutions and manuscripts for monitoring drug dose parameters to avoid unusual dangerous effects risking the patient life. We conclude that monitoring the disease as well as the treatment pharmacokinetics is mandatory to better carry on CML patients.

Posterior reversible encephalopathy syndrome in leukemic children: a sensitive issue.

Posterior reversible encephalopathy syndrome (PRES) is an acute central nervous system disorder characterized by reversible brain vasogenic edema. We report here a new case of a nine-year-old boy with B-cell acute lymphoblastic leukemia (B-ALL) who developed PRES secondary to induction chemotherapy including dexamethasone (dexamethasone®), vincristine (oncovin(®)), daunorubicin (adriblastine(®)) and intrathecal injection. Cerebral magnetic resonance imaging (MRI) showed high signal intensity on T2 at cortical and sub cortical region of parieto-frontal and parieto-occipital lobes. The patient was put under sodium valproate (depakine(®)) and we decided to continue dexamethasone (dexamethasone(®)) and daunorubicin (adriblastine(®)) injection. The MRI, after four weeks, was normal. So, we resumed vincristine (oncovin(®)) and we started L-asparaginase injections. Then, the outcome was favorable. The treatment of PRES is based on the withdrawal of the triggering factor to avoid the risk of irreversible lesions. But, due to the severity of leukemia the discontinuation of chemotherapy is difficult because of the risk of disease progression.

[Adult lymphocytosis etiology by flow cytometry]. / Classification par cryométrie en flux de 104 cas d'hyperlymphocytose de l'adulte.

BACKGROUND: Positive and differential diagnosis of chronic lymphocytic leukemia (CLL) is based on immunophenotyping analysis. CLL is searched whenever a persistent lymphocytosis is found. AIM: To evaluate the performance of flow cytometry in etiologic diagnosis of lymphocytosis. Could it allow us to distinguish CLL from other causes of lymphocytosis? METHODS: Blood samples from 104 adult patients having a rate of lymphocytes> 5000 élé/mm3 persisting more than three months were analyzed using a large panel of monoclonal antibodies in three colors and Cell Quest software. results: Lymphoproliferative B disorder was retained in 83 cases, including 50 cases of typical CLL with Matutes score≥ 4 and 12 cases of atypical CLL with Matutes score = 3 . Diagnosis of hairy cell leukemia and follicular lymphoma were guided by the respective specific antigen expression CD103 and CD10. Large granular T lymphoma (LGL-T) was the most common etiology of lymphoid T proliferation. Unusual cases of Natural Killer (NK) and NK/T proliferations were found. CONCLUSION: The Flow cytometry is a powerful tool to establish lymphocytosis etiological diagnosis; it avoids invasive investigations in a large number of cases.

Megaloblastic anemia in North Africa.

We prospectively studied 478 patients with megaloblastic anemia living in Tunisia. Overall, 98% of patients had vitamin B12 deficiency. Pernicious anemia accounted for most of these cases, and median age at presentation was 45 years. Megaloblastic anemia occurred in 19 subjects under 15 years of age, and of these, nine had the Immerslund-Graesbeck syndrome.