Akciğer Kanseri Tedavisinde Ortaya Çıkan Kronik Myeloid Lösemi: Nadir Bir Olgu
Özet
Kronik miyeloid lösemi (KML), BCR/ABL1 füzyon geni oluşumu ile karakterize kronik bir miyeloproliferatif hastalık olup, solid tümörlerle birlikteliği nadirdir. Burada metastatik akciğer adenokarsinomu nedeniyle tedavi alan hastada gelişen KML olgusunu bildiriyoruz. Hasta başlangıçta evre IIIA akciğer adenokarsinomu tanısı aldı ve konvansiyonel kemoterapi sonrası gelişen metastatik hastalık nedeniyle yaklaşık 30 ay nivolumab tedavisi aldı. Takip sırasında ortaya çıkan progresif lökositoz nedeniyle yapılan hematolojik değerlendirmede belirgin nötrofili, trombositoz görüldü ve periferik yaymada sola kayma, eozinofili ve bazofili saptandı. Moleküler incelemelerde BCR/ABL1 pozitifliği gösterilerek hastaya kronik faz KML tanısı kondu. İmatinib mesilat tedavisi sonrasında hızlı hematolojik yanıt elde edildi ancak hasta tedavinin 26. gününde gelişen akut solunum yetmezliği nedeniyle kaybedildi. Bu olgu, akciğer kanseri hastalarında gelişen persistan lökositozun değerlendirilmesinde miyeloproliferatif hastalıklarında ayırıcı tanıda göz önünde bulundurulması gerektiğini göstermektedir.
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