Secondary nasopharyngeal carcinoma in a patient with chronic myeloid leukemia on long-term imatinib therapy: a case report

Desta Nur Ewika Ardini; Eko Adhi Pangarsa; Daniel Rizky; Damai Santosa; Budi Setiawan; C. Suharti

doi:10.22146/inajbcs.v57i3.Supplement.24564

Desta Nur Ewika Ardini Haematology Oncology Staff Division, Department of Internal Medicine, Faculty of Medicine Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia
Eko Adhi Pangarsa Haematology Oncology Staff Division, Department of Internal Medicine, Faculty of Medicine Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia
Daniel Rizky Haematology Oncology Staff Division, Department of Internal Medicine, Faculty of Medicine Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia
Damai Santosa Haematology Oncology Staff Division, Department of Internal Medicine, Faculty of Medicine Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia
Budi Setiawan Haematology Oncology Staff Division, Department of Internal Medicine, Faculty of Medicine Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia
C. Suharti Haematology Oncology Staff Division, Department of Internal Medicine, Faculty of Medicine Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia

DOI: https://doi.org/10.22146/inajbcs.v57i3.Supplement.24564

Keywords: CML, nasopharyngeal carcinoma, imatinib, secondary malignancy, tyrosine kinase inhibitor

Abstract

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by the BCR-ABL1 fusion gene and commonly treated with tyrosine kinase inhibitors (TKIs), notably imatinib. While TKIs have significantly improved survival, concerns have emerged regarding potential long-term complications, including secondary malignancies. We report the case of a 50-year-old male with CML diagnosed in 2015, based on bone marrow aspiration and BCR-ABL positivity, maintained on imatinib with stable disease. In May 2023, he presented with profuse epistaxis for three days, fatigue, subauricular swelling, and hoarseness of voice. No petechiae, gingival bleeding, or systemic symptoms were noted. On evaluation, a mass in the nasopharynx was visualized via nasopharyngoscopy, with extension into the nasal cavity and suspicion for malignancy. The MSCT scan revealed a fragile, easily bleeding solid mass located in the nasopharynx, with bilateral extension into the nasal cavities. A biopsy followed by immunohistochemistry confirmed the diagnosis of a malignant epithelial tumor. Treatment with imatinib was maintained, alongside cisplatin-based chemotherapy and external radiotherapy. Notably, the patient showed favorable clinical improvement after completing 25 sessions of radiotherapy. This case highlights the rare occurrence of nasopharyngeal carcinoma (NPC) developing in a CML patient on long-term imatinib. Though imatinib is not classified as carcinogenic, its immunomodulatory effects may impair tumor surveillance, potentially predisposing to secondary malignancies. Clinicians should maintain a high index of suspicion for secondary malignancies in patients with CML presenting with new, localized symptoms, particularly those involving the head and neck region. Long-term follow-up and comprehensive evaluation are essential to detect and manage rare but significant complications such as secondary nasopharyngeal carcinoma.