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Background
Introduction of small tyrosine kinases (TKIs) has improved survival in patients with chronic myeloid leukaemia (CML). Imatinib is a small-molecule TKI used in CML treatment, and it improves insulin sensitivity. 1 Dasatinib is also a breakpoint cluster region protein/Abelson murine leukaemia viral oncogene homolog-l and proto-oncogene tyrosine-protein kinase Src family TKI. 2 However, the effect of dasatinib on the metabolism of glucose and lipids is not known. We report a case of a patient with concurrent CML and type-2 diabetes mellitus (T2DM), in whom we estimated insulin sensitivity and lipid metabolism.
Case presentation
A 65-year-old woman had been receiving T2DM treatment from our department since December 2012. Glycated haemoglobin (Hb)A1c levels were well controlled ([approximate]5.8% (40 mmol/mol)) by metformin (500 mg). In July 2014, the patient's white cell count increased suddenly to 33 530 cells/[mu]L; basophils (7.5%) and HbA1c (6.2% (44 mmol/mol)) were also elevated slightly ( table 1 ). Plasma levels of vitamin B12 were higher (1450 (180-914) pg/mL) and the neutrophil alkaline phosphatase score was low (136 (188.5-367.0)). We suspected CML and consulted a haematologist. Chromosome staining by G-banding (46, XX, t [9;22][q34;q11.2]) on bone-marrow examination prompted a diagnosis of Ph+ CML. In August 2014, the patient was started on dasatinib (100 mg).
Table 1
Blood | Biochemistry | Metabolism | |||
WCC | 33 530 /[mu]L | TP | 7.1 g/dL | Glucose | 115 mg/dL |
RBC | 535 x104 /[mu]L | Alb | 4.6 g/dL | IRI | 6.9 [mu]U/mL |
Hb | 14.6 g/dL | CK | 19 IU/L | HbA1c | 6.2 % |
Hct | 44 % | AST | 20 IU/L | T Chol | 147 mg/dL |
MCV | 82.2 fL | ALT | 10 IU/L | TG | 266 mg/dL |
MCH | 27.3 pg | LDH | 471 IU/L | HDL-c | 32 mg/dL |
Plt | 66.3 x104 /[mu]L | ALP | 179 IU/L | - | - |
Ret | 2.14 % | [GAMMA] GTP | 16 IU/L | - | - |
- | - | AMY | 109 IU/L | Other | - |
Blast | 0.5 % | Cre | 0.47 mg/dL | ALP (NAP) Score | - |
Myelocyte | 6 % | BUN | 17.6 mg/dL | Type0 | 38 % |
Metamyelocyte | 2 % | Na | 143 mEq/L | Type1 | 10 % |
Stab | 4 % | K | 4.6 mEq/L | Type2 | 31 % |
Seg | 58.5 % | Cl | 107 mEq/L | Type3 | 20 % |
Neut | 62.5 % | Ca | 9.9 mg/dL | Type4 | 1 % |
Mono | 3 % | Pi | 4 mEq/L | Type5 | 0 % |
Lymp | 17 % | Fe | 85 [mu]g/dL | Positive ratio | 62 % |
Eosino | 1.5... |