Acute cardiotoxicity after initiation of the novel tyrosine kinase inhibitor gilteritinib for acute myeloid leukemia

Gilteritinib is a novel tyrosine kinase inhibitor recently approved by the United States Food and Drug Administration in 2018 for relapsed or refractory Acute Myeloid Leukemia (AML). However, gilteritinib may be associated with previously underrecognized cardiotoxicities. This case describes a patient without prior cardiovascular history who was diagnosed with relapsed AML. After six doses of gilteritinib initiation, she abruptly developed acute systolic heart failure with global hypokinesis and septal wall motion abnormalities. Two days after discontinuation, cardiac Magnetic Resonance Imaging (MRI) showed recovery of her Left Ventricular Ejection Fraction (LVEF) as well as myocardial edema and non-ischemic fibrosis suggestive of inflammatory cardiomyopathy. She was started on guideline directed heart failure therapy. Follow up cardiac MRI five months later showed recovery of LVEF with mild non-ischemic fibrosis and resolution of myocardial edema and inflammation. She later received an allogeneic stem cell transplant from a matched unrelated donor.