FLT3 inhibitor-induced neutrophilic dermatosis

Blood. 2013 Jul 11;122(2):239-42. doi: 10.1182/blood-2013-01-478172. Epub 2013 May 17.

Abstract

The FLT3-ITD mutation is associated with poor outcomes in acute myeloid leukemia. Multiple FMS-like tyrosine kinase 3 (FLT3)-inhibitors have been studied in clinical trials. Recently, potent FLT3 inhibition was shown to induce terminal differentiation of FLT3-mutant myeloblasts. In 3 patients who developed characteristic skin nodules on initiation of FLT3-inhibition, we conducted dermatopathologic evaluation of skin samples, as well as FLT3 and NPM1 mutational analysis and fluorescence in situ hybridization. All 3 patients demonstrated characteristically deep dermal and subcutaneous neutrophilic infiltrates without evidence of myeloblasts. Discovery of FLT3-ITD and NPM1 mutations in 2 of the samples, as well as the presence of FLT3-ITD and deletion of 7q in the other, confirmed the ancestry of the differentiated neutrophils as that of the original FLT3-mutant myeloblasts. FLT3 inhibition can lead to clinically distinct dermatoses, which suggests the effect of FLT3 inhibition on myeloid differentiation and a manifestation of a broader "syndrome" associated with this therapy.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Biopsy
  • Chromosome Aberrations
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mutation
  • Neutrophil Infiltration*
  • Nucleophosmin
  • Protein Kinase Inhibitors / adverse effects*
  • Skin / pathology
  • Skin Diseases / chemically induced*
  • Skin Diseases / genetics
  • Skin Diseases / pathology*
  • fms-Like Tyrosine Kinase 3 / antagonists & inhibitors*
  • fms-Like Tyrosine Kinase 3 / genetics

Substances

  • NPM1 protein, human
  • Protein Kinase Inhibitors
  • Nucleophosmin
  • fms-Like Tyrosine Kinase 3