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Reactivation of porphyria cutanea tarda as a possible side effect of Imatinib at high dosage in chronic myeloid leukemia

Leukemia volume 18, page 182 (2004)Cite this article

TO THE EDITOR

Imatinib mesylate is a signal transduction inhibitor that specifically targets a set of protein tyrosine kinases, abl, c-kit, platelet-derived growth factor receptor (PDGF-R).1,2,3 In chronic myeloid leukemia (CML), this drug shows impressive efficacy, with rates of complete hematological response of 95%.1 Common nonhematological side effects reported in the literature have included nausea, fluid retention with weight gain, muscle cramps and fatigue.4 A recent publication of Milojkovic et al5 has reported the dermatological toxicity secondary to Imatinib therapy, with the description of a unique dermatitis related to this drug and a possibility of severe adverse cutaneous reactions. Herein, we describe another possible dermatological side effect that can be precipitated by Imatinib: porphyria cutanea tarda (PCT). A 67-year-old woman was diagnosed at our Institute in 1988 as having CML and was treated with interferon (IFN)-alpha from 1988 to 1993. She achieved complete hematological response, in the absence of cytogenetic remission. In 1993, while undergoing IFN treatment, the patient reported the appearance of spontaneous and painless hemorrhagic blisters on the sun-exposed surface of both hands and both feet. Skin biopsy demonstrated lymphohistiocytic infiltrate of the derma. Porphyrin fractions were tested and a high level of uroporphyrin was found in random urine samples (64.8%, normal <20%), leading to the diagnosis of PCT. IFN treatment was discontinued and the patient was treated only with hydroxyurea, with complete resolution of the skin lesions and the return of porphyrin levels to normal. In November 2000, the CML progressed to a blastic crisis, and Imatinib at 600 mg/daily was administered; successful control of leukocytosis was only obtained on increasing the dose to 800 mg/daily, at 14 weeks of therapy.

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Authors and Affiliations

  1. Department of Cellular Biotechnologies and Hematology, University La Sapienza of Roma, Roma, Italy

    M Breccia, R Latagliata, I Carmosino, F Mandelli & G Alimena

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  1. M Breccia
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  2. R Latagliata
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  3. I Carmosino
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  4. F Mandelli
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  5. G Alimena
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Breccia, M., Latagliata, R., Carmosino, I. et al. Reactivation of porphyria cutanea tarda as a possible side effect of Imatinib at high dosage in chronic myeloid leukemia. Leukemia 18, 182 (2004). https://doi.org/10.1038/sj.leu.2403115

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