Abstract
Chronic myeloid leukemia (CML) is a clonal hematopoietic disorder caused by an acquired
genetic defect in a pluripotent stem cell. A series of discoveries led to the recognition
that the BCR-ABL protein, which results from a reciprocal translocation involving
chromosomes 9 and 22, has a central role in the pathogenesis of chronic myelogenous
leukemia. The BCR-ABL protein functions as a constitutively activated tyrosine kinase
(TK) and this knowledge led to the development of imatinib (STI-571), a drug that
specifically inhibits the BCR-ABL TK. Common side effects of imatinib are low blood
counts, nausea and vomiting, edema (swelling of the face, feet, and hands), muscle
cramps and bone pain, diarrhea, hemorrhage, skin rash, and fever. Headache, fatigue,
joint pain, indigestion, and abdominal pain are occasionally seen, and liver toxicity
is a rare complication. We here report a case of multiple small bowel perforations
in a patient of Ph+ve chronic myeloid leukemia-chronic phase on imatinib. Bowel perforation is a known
complication for targeted therapy agents like bevacizumab, sunitinib, and sorafenib,
which act on vascular endothelial growth factor receptor but imatinib having no anti
VEGF receptor activity leading to such complication is a mystery. Physician treating
their patient with imatinib should be aware of this complication and should act accordingly.
Keywords
Antivascular endothelial growth factor receptor - bowel perforation - chronic myeloid
leukemia - imatinib - tyrosine-kinase inhibitor
