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Late-onset Imatinib-induced Liver Failure Treated with Dasatinib for Two Years Resulted in Long-term Undetectable Response

Koiti Inokuchi, Muneo Okamoto, Kazutaka Nakayama, Hayato Tamai and Hiroki Yamaguchi

A 21-year-old man who was diagnosed with chronic-phase CML and treated with imatinib (400 mg/day) during September 2004 achieved a complete molecular response within 14 months. His liver function remained normal during this period. The results of liver function tests after four years of treatment showed AST, 547 IU/L; ALT, 1124 IU/L, and viral hepatitis and autoimmune hepatitis were undetectable. Drug toxicity was suspected and imatinib was immediately discontinued. A liver biopsy showed hemorrhagic necrosis and hemosiderin deposition around the central vein indicating a diagnosis of imatinib-induced liver failure. Aminotransferases normalized within three months after imatinib withdrawal. Seven months after imatinib discontinuation, bcr-abl transcripts were detected twice during the next four months. Thus, dasatinib (100 mg) was administered, which resulted in an undetectable molecular response within two months. The patient decided to stop taking dasatinib two years after achieving the undetectable molecular response and he has remained in this condition for four years since. Patients with liver damage require follow-up. To confirm the benefit of changing medication from imatinib or other drugs to dasatinib will require more information from accumulated cases.