Diagnosis and treatment of imatinib-induced interstitial lung disease and literatures review

Abstract

Objective To investigate the diagnosis and treatment of imatinib induced interstitial lung disease (ILD), providing clinical reference for early diagnosis, treatment and alternative medicine selection, and improving the prognosis of patients. Methods On 3 June 2016, a case of imatinib induced ILD who was admitted to Department of Hematology, West China Hospital, Sichuan University was included in this study. The patient was diagnosed with chronic myeloid leukemia (CML) and started therapy of imatinib on 15 December 2015. When the patient was admitted, bone marrow morphology, cytogenetic, medical imageological and pathological examination were conducted and diagnosis was made base on those test results and patient′s medical history and medication history. Then imatinib discontinued on 6 July 2016 and started 30 mg/d prednisone therapy on 29 July 2016 with 6-month duration. Switched to nilotinib 300 mg twice daily on 20 December 2016. Follow-up (up to 5 September 2017) was performed to monitor the efficacy. Clinical features, diagnosis and treatment of this patient were analyzed retrospectively, and related literatures were reviewed. Results ① When the patient was admitted, results of bone marrow morphology, genetic examinations were all within normal range. Chest high resolution (HR) CT scan revealed lung marking increased, disordered, and blurred; and there were diffusely distributed multiple ground glass opacity, small patchy, and fibrous stripes. Results of lung puncture biopsy suggested chronic inflammation changed with fibrous tissue hyperplasia. ② Patient was diagnosed with imatinib-induced ILD. ③ Patient suspended imatinib were treated with prednisone, and the symptoms of cough and anhelation were significantly improved. After 6 weeks, the chest HRCT indicated a significant decrease in the bilateral lung lesions. After 6 months of nilotinib application, no significant abnormalities were observed in bone marrow morphology, genetic examination and HRCT results. And complete cytogenetic remission (CCyR) and deep molecular remission were achieved. The patient was well tolerated during follow-up. Conclusions The appearance of dyspnea after imatinib treatment should be considered the possibility of imatinib-induced ILD. Early diagnosis, discontinuation of imatinib and application of glucocorticoid can significantly improve prognosis of imatinib-induced ICD. In this case report, the patient with imatinib-induced ILD who was switched to nilotinib was well tolerated and CML treatment response was good, which could provide a reference for the clinical medication of CML. Key words: Imatinib; Interstitial pneumonia; Glucocorticoid; Nilotinib; Diagnosis