Cirrhosis Caused by Nilotinib in Dose-Dependent Hepatotoxicity: Role of Gamma-Glutamyl Transferase in Management

We report nilotinib hepatotoxicity in a patient with chronic myeloid leukemia (CML) who presented with isolated elevations of gamma-glutamyl transferase (GGT). Cirrhosis was confirmed by clinical, radiologic, and histologic findings. Therapy for CML was continued, guided by monitoring BCR-ABL1 levels and declining GGT levels. Cirrhosis regression was evaluated using liver stiffness measurements and histology. Isolated GGT elevations in diagnosis and improvement in hepatotoxicity with dose reduction have not been previously reported. Treatment continuation while monitoring GGT and BCR-ABL1 levels resulted in disease remission and regression of cirrhosis. Our report will be useful to clinicians managing patients treated with nilotinib.