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Diabetes Mellitus After Nilotinib Treatment for CML: Case Study

By: Kayci Reyer
Posted: Wednesday, December 2, 2020

A case study published in Cureus describes a Chinese woman with chronic-phase chronic myeloid leukemia (CML) who developed diabetes mellitus after treatment with the second-generation tyrosine kinase inhibitor nilotinib. Adverse effects associated with nilotinib treatment may also include cardiovascular complications, cytopenias, and pancreatitis.

“To the best of our knowledge, the management of nilotinib-induced diabetes doesn’t differ from that of type 2 diabetes, and this adverse effect seems to respond to the same first-line agents used to manage type 2 diabetes,” concluded Mohamed A. Yassin, of Hamad General Hospital, Doha, Qatar, and colleague.

In February 2017, the patient, aged 45, was found to have leukocytosis with basophilia during a complete blood cell count test. The patient was asymptomatic, but her leukocyte count was 240,000 x 103/mL with a left shift and basophilia. Hyperleukocytosis, neutrophilic cells, basophilia, and 1% blasts were detected on a peripheral blood smear, with hypercellularity and granulocytic hyperplasia and prominent basophils/eosinophils appearing on a bone marrow aspirate smear. A bone marrow biopsy and immunohistologic staining were performed, revealing cellularity near 100%, trilineage hematopoiesis, and marked granulocytic proliferation as well as increased marrow vasculature and increased megakaryocytes, including dwarf forms. Fluorescence in situ hybridization (FISH) analysis identified an abnormal hybridization signal pattern with dual fusion, suggesting a rearrangement of BCR/ABL1 in 197 of the 200 evaluated cells. The patient’s case was consistent with chronic-phase CML.

In March 2017, the patient began receiving upfront nilotinib treatment, achieving a complete hematologic response, complete cytogenetic response, and major molecular response. In August 2018, she presented to the emergency room. While there, her blood sugar was measured at 20 mmol/L, though she had no symptoms of diabetes. Metformin treatment was initiated, and nilotinib therapy continued unaltered. During follow-up visits, the patient’s blood sugar values were within normal limits.

Disclosure: For full disclosures of the study authors, visit cureus.com.



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