Nilotinib-Induced Unilateral Renal Artery Stenosis: A Complication Prompting Treatment-Free Remission in Chronic Myeloid Leukemia.

Renal artery stenosis (RAS) is a rare but significant vascular complication associated with nilotinib therapy for chronic myeloid leukemia (CML). We present the case of a woman in her mid-70s on long-term nilotinib who developed this adverse event. The patient presented with a progressive, insidious decline in renal function over several years. Diagnostic evaluation revealed severe unilateral stenosis of the left renal artery. Under nilotinib, the patient had maintained a sustained deep molecular response (DMR), making her a candidate for treatment-free remission (TFR). The development of RAS prompted the discontinuation of nilotinib, both as a therapeutic intervention for her kidney disease and to initiate a trial of TFR. Following discontinuation, the patient's renal function showed partial but significant improvement, suggesting a causal relationship. This case describes the importance of recognizing subtle presentations of TKI-induced vascular complications, particularly unilateral RAS, and illustrates how managing such adverse events intersects with modern CML therapeutic goals like TFR.