Acute lymphocytic leukemia in a patient with long-term carbamazepine exposure: Acute lymphoblastic leukemia that develops in a patient who has been using carbamazepine for a long time

J Oncol Pharm Pract. 2023 Mar;29(2):477-478. doi: 10.1177/10781552221105856. Epub 2022 Jun 3.

Abstract

Introduction: Carbamazepine is an antiepileptic drug used in the treatment of epilepsy, trigeminal neuralgia, and bipolar disorder. Hematological effects that may develop with this anticonvulsant; agranulocytosis, thrombocytopenia, leukopenia, aplastic anemia, eosinophilia, or pancytopenia.

Case report: In this article, we wanted to present a case diagnosed with acute lymphoblastic leukemia after long-term use of carbamazepine because of epilepsy.

Management and outcome: Bone marrow smear was evaluated and blastic cell infiltration was observed. The carbamazepine treatment was discontinued and standard chemotherapy was started for acute lymphoblastic leukemia (CALGB protocol). Levetiracetam was started for epilepsy.

Discussion: Carbamazepine is an iminostilbene derivative. Carbamazepine is an antiepileptic drug that exhibits a number of side effects such as headache, abdominal pain, high blood pressure, as well as hematological disorders. In addition to causing thrombocytopenia, hypogammaglobulinemia, leukopenia, and neutropenia, it can have serious effects such as agranulocytosis, aplastic anemia, pure red cell aplasia, leukemia, or DRESS syndrome. The incidence of serious side effects from carbamazepine pharmacotherapy is low, and their exact mechanism of action is still unknown.

Keywords: Acute lymphoblastic leukemia; carbamazepine; cytopenia.

Publication types

  • Case Reports

MeSH terms

  • Anemia, Aplastic* / chemically induced
  • Anticonvulsants / adverse effects
  • Carbamazepine / adverse effects
  • Epilepsy* / chemically induced
  • Epilepsy* / drug therapy
  • Humans
  • Neutropenia* / chemically induced
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma* / drug therapy
  • Thrombocytopenia* / chemically induced
  • Thrombocytopenia* / drug therapy

Substances

  • Anticonvulsants
  • Carbamazepine