Severe Peripheral Arterial Occlusive Disease In Chronic Myeloid Leukemia Patient During Nilotinib Therapy: Report Of A Case And Review Of Literature

Nilotinib, the second-generation tyrosine kinase inhibitor (TKI), is initially designed and used to overcome resistance or intolerance of the first-generation agent imatinib. Despite improvements in complete cytogenetic response (CCyR) and deep molecular response compared with the first generation TKI, cardiovascular safety is becoming a big problem for patients with chronic myeloid leukemia (CML) receiving nilotinib. Such cardiovascular adverse events (CVE) include peripheral artery occlusive disease (PAOD), myocardial infarction, stroke, unstable angina. Hypertension, dyslipidemia, coronary arterial disease, congestive heart failure and chronic renal failure are associated with a higher risk of CVE. Here we described a patient suffering from unexpected and rapid onset of symptomatic PAOD during nilotinib treatment. Although arterial damage was irreversible, functional outcome was satisfactory upon rapid drug withdrawal and surgery.