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ALK-Inhibitor–Induced Spheroacanthocytosis
March-April 2022, Volume 19, Issue 2

ALK-Inhibitor–Induced Spheroacanthocytosis

Priscilla Yeung MD, PhD,1 Fei Fei, MD,2 and Sebastian Fernandez-Pol, MD, PhD3
1. Clinical Pathology Resident, Department of Pathology, Stanford University School of Medicine, Stanford, CA
2. Hematopathology Fellow, Department of Pathology, Stanford University School of Medicine, Stanford, CA
3. Clinical Assistant Professor, Department of Pathology, Stanford University School of Medicine, Stanford, CA
Published on: February 22, 2022

A 42-year-old man with metastatic lung adenocarcinoma presented with disease progression on positron emission tomography/computed tomography scan after 15 months of stable disease while on pembrolizumab. Molecular testing revealed an EML4-ALK fusion, and the patient was started on the anaplastic lymphoma kinase (ALK) inhibitor alectinib. Prior to alectinib therapy, his hemoglobin ranged from 12.3 to 13 g/dL. Three months after initiating therapy, his hemoglobin ranged from 11.5 to 12 g/dL (Table). Review of peripheral blood smears while on alectinib therapy revealed marked acanthocytosis with occasional schistocytes, spherocytes, and microcytes (Figure).

 Test Result Reference Range 
Hemoglobin 11.8 g/dL
 13.5-17.7 g/dL
Hematocrit 34.5%  40-52%
Mean cell volume 73.5 fL  82-98 fL
Mean corpuscular hemoglobin concentration 34.3 g/dL  32-36 g/dL
Red cell distribution width 23.5%  11.5-14.5%
Platelet count 341 × 109/L  150-400 × 109/L
White cell count 10.1 × 109/L  4-11 × 109/L
Total bilirubin 1.3 mg/dL  0.2-1.3/0-0.3 mg/dL

Dr. Yeung, Dr. Fei, and Dr. Fernandez-Pol indicated no relevant conflicts of interest.

 
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