Avascular necrosis of femoral head: a rare case as a symptom of the chronic phase in adult chronic myelogenous leukemia patients on nilotinib therapy


  • Ni Kadek Seri Mahayanti Sanjiwani General Hospital, Gianyar,Bali, Indonesia
  • Dewa Gde Agung Budiyasa Department of Internal Medicine, Sanjiwani General Hospital, Gianyar, Bali, Indonesia




AVN of femoral head, CML, Nilotinib


Chronic myelogenous leukemia (CML) is a malignant clonal disorder of hematopoietic stem cells characterized by abnormal proliferation and accumulation of immature granulocytes. Avascular necrosis (AVN) is a rare case in CML patients where a systematic review reported only 21 cases from 1984 to 2021 of which 17 cases were AVN of the femoral head (AVNFH) and 3 cases were associated with treatment with tyrosine kinase inhibitors, namely imatinib, desatinib and nilotinib. We report a 51-year-old male patient with complaints of hip joint pain. The patient was diagnosed with CML from bone marrow examination with hypercellular results and PCR examination which detected the presence of BCR-ABL transcription in the form of b2a2 fusion. The patient received nilotinib 200 mg every 12 hours. The diagnosis of AVN was established from clinical symptoms and radiological examination. The patient was planned to undergo a total hip replacement.


Zafar MZ. Patient with Chronic Myeloid Leukemia: A Case Study. J Cancer Sci Ther. 2017;9: 635-6.

Moon JY, Kim BS, Yun HR. A Case of Avascular Necrosis of the Femoral Head as Initial Presentation of Chronic Myelogenous Leukemia. Korean J Intern Med. 2005;20:255-9.

Thompson PA, Kantarjian H, and Cortes JE. Diagnosis and Treatment of Chronic Myeloid Leukemia (CML) in 2015. Mayo Clin Proc. 2015;90(10):1440-54.

Yassin et al. Dasatinib Induced Avascular Necrosis of Femoral Head in Adult Patient with Chronic Myeloid leukemia. Clinical Medicine Insights: Blood Disorders. 2015;8:19-23.

Gupta D, Gaiha M, Siddaraju N, Daga MK, Anuradha S. Chronic Myeloid Leukemia Presenting with Avascular Necrosis of Femur Head. J Asso Physicians India. 2003;51:214-5.

Hasford J, Baccarani M, Hoffmann V. Predicting complete cytogenetic response and subsequent progression-free survival in 2060 patients with CML on imatinib treatment: the EUTOS score. Blood. 2011;118(3):686-92.

Sasaki K, Strom SS, O’Brien S. Relative survival in patients with chronic-phase chronic myeloid leukaemia in the tyrosine-kinase inhibitor era: analysis of patient data from six prospective clinical trials. Lancet Haematol. 2015;2(5):186-93.

Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1995;77(3):459-74.

Al-Mashdali AF, Al-Dubai HN, Yassin MA. Avascular necrosis in patients with chronic myeloid leukemia: A systematic review. Acta Biomed. 2022;93(1):1-11.

Suresh K, Bansal D, Prakash M, Sharma P. Avascular Necrosis of Femoral Head as the Initial Manifestation of CM. Pediatr Hematol Oncol. 2014;31:568-73.

Hughes C, Patterson K, Murray M. Avascular necrosis of the femoral head in childhood chronic myeloid leukaemia. Br J Haematol. 2007;139 (1):1.

Stucki A, Rivier AS, Gikic M, Monai N, Schapira M, Spertini O. Endothelial cell activation by myeloblasts: molecular mechanisms of leukostasis and leukemic cell dissemination. Blood. 2019;7:2121-9.

Tekkudan SF, Nityanand S. Nilotinib induced avascular necrosis of femoral head in an adult chronic myeloid leukemia patient. J Clin Orthop Trauma. 2018;9(2):26-8.

Nataraj V, Kandasamy D, Bakhshi S. Imatinib-induced avascular necrosis of femur in childhood chronic myeloid Leukemia. Pediatr Hematol Oncol. 2014;31:268-70.






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