Chronic myelomonocytic leukemia blast crisis in a patient with advanced non-small cell lung cancer treated with EGFR tyrosine kinase inhibitors

Hiroaki Ogata; Isamu Okamoto; Goichi Yoshimoto; Teppei Obara; Kayo Ijichi; Eiji Iwama; Taishi Harada; Koichi Akashi; Yoichi Nakanishi

doi:10.1016/j.resinv.2016.12.002

Chronic myelomonocytic leukemia blast crisis in a patient with advanced non-small cell lung cancer treated with EGFR tyrosine kinase inhibitors

Respir Investig. 2017 Mar;55(2):181-183. doi: 10.1016/j.resinv.2016.12.002. Epub 2017 Jan 12.

Authors

Hiroaki Ogata¹, Isamu Okamoto², Goichi Yoshimoto³, Teppei Obara³, Kayo Ijichi⁴, Eiji Iwama⁵, Taishi Harada¹, Koichi Akashi³, Yoichi Nakanishi¹

Affiliations

¹ Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
² Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. Electronic address: okamotoi@kokyu.med.kyushu-u.ac.jp.
³ Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
⁴ Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
⁵ Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.

PMID: 28274536
DOI: 10.1016/j.resinv.2016.12.002

Abstract

A 59-year-old woman with epidermal growth factor receptor gene (EGFR) mutation-positive advanced lung adenocarcinoma was treated with afatinib after a diagnosis of chronic myelomonocytic leukemia (CMML). Twenty-one weeks later, she developed agranulocytosis, and CMML subsequently progressed to blast crisis. After complete remission of CMML, gefitinib was initiated; however, agranulocytosis recurred. This is the first reported case of both EGFR mutation-positive advanced non-small cell lung cancer with CMML, and of CMML blast crisis. Physicians should be aware of such risks and monitor EGFR-TKI-treated patients with myeloid neoplasms accordingly.

Keywords: Afatinib; Chronic myelomonocytic leukemia; Epidermal growth factor receptor (EGFR); Gefitinib; Non-small cell lung cancer.

Publication types

Case Reports

MeSH terms

Afatinib
Agranulocytosis / etiology
Blast Crisis / drug therapy*
Blast Crisis / etiology*
Carcinoma, Non-Small-Cell Lung / complications
Carcinoma, Non-Small-Cell Lung / drug therapy*
Carcinoma, Non-Small-Cell Lung / genetics
Female
Gefitinib
Genes, erbB-1 / genetics
Humans
Leukemia, Myelomonocytic, Chronic / complications
Leukemia, Myelomonocytic, Chronic / drug therapy*
Leukemia, Myelomonocytic, Chronic / pathology*
Lung Neoplasms / complications
Lung Neoplasms / drug therapy*
Lung Neoplasms / genetics
Middle Aged
Mutation
Protein Kinase Inhibitors / adverse effects
Protein Kinase Inhibitors / therapeutic use*
Quinazolines / adverse effects
Quinazolines / therapeutic use*

Substances

Protein Kinase Inhibitors
Quinazolines
Afatinib
Gefitinib