Linda MCLAUGHLIN · Prevention of Future Deaths report

On 1st November 2023 I commenced an investigation into the death of Linda MCLAUGHLIN. The investigation concluded on the 16th May 2024 and the conclusion was one of NARRATIVE: Death from bronchopneumonia contributed to by the complications of previous drug therapy. The medical cause of death was 1a) Bronchopneumonia II) Drug induced Interstitial Lung disease, Chronic Myeloid Leukaemia, Steroid therapy.

In 2014 Linda McLaughlin was diagnosed with Chronic Myeloid Leukaemia (CML) and treated with a tyrosine kinase inhibitor drug (nilotinib). She responded well to the treatment and by October 2021 was in molecular remission. She remained on a low dose of nilotinib. In April 2023 she was becoming increasingly breathless and went to Royal Oldham Hospital where a scan in May 2023 found she had developed interstitial lung disease probably as a consequence of nilotinib treatment. She was treated with steroids for interstitial lung disease and the nilotinib was stopped. On 23rd October 2023 she was admitted to Tameside General Hospital where she was treated for bronchopneumonia and was very unwell. She deteriorated and died at Tameside General Hospital on 27th October 2023

1. The inquest heard evidence that the complication that Mrs McLaughlin developed is rare but recognised internationally. However it is not widely known about and as a consequence of lack of awareness even amongst oncologists/haematologists it may not be recognised that a patient has symptoms of interstitial lung disease and as a consequence referral and treatment that could slow the disease progression may be delayed.
2. The inquest was told that the consenting process for starting a patient on a drug such as nilotinib would not ordinarily include mentioning rare complications such as interstitial lung disease. The family gave evidence that in this case this is something that would have been carefully weighed in the decision to proceed with the treatment.
3. In this case the inquest was told that a decision was taken to continue with nilotinib despite being in remission. The inquest was told that there is growing evidence that some people do not need to stay on these drugs for life if in remission but there is no clear guidance for the approach to take. As a consequence patients may remain on the drug longer than necessary.