Dasatinib-induced massive left chylothorax in a patient with chronic myeloid leukemia

Makimoto, Go; Misawa, Mahito; Maeda, Yoshinobu; Kiura, Katsuyuki

doi:10.1016/j.rmcr.2022.101662

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…In cases of drug-induced chylothorax, symptoms were resolved by discontinuing the medication. [ 22 , 23 ] In our case, a huge intra-abdominal mass was noted on PET scan prior to CAR-T cell therapy and there was no chylothorax or pleural effusion observed initially. After CAR-T cell therapy, a chest plain film revealed pleural effusion bilateral and abdominal sonography showed moderate ascites.…”

Section: Discussionmentioning

confidence: 57%

Chylothorax after chimeric antigen receptor T cell therapy for relapsed and refractory diffuse large B-cell lymphoma: A case report

Chen,

Kuo,

et al. 2023

Medicine

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Rationale: Anti-CD19-targeted chimeric antigen receptor (CAR) T cell therapy is effective in treating relapsed/refractory diffuse large B-cell lymphoma (DLBCL). This therapy is associated with several side effects that can be life-threatening such as cytokine release syndrome (CRS). However, chylothorax associated with CRS after CAR-T therapy has not been reported. Patient concerns: A 23-year-old male diagnosed with DLBCL relapsing after autologous peripheral blood stem cell transplantation was treated with anti-CD19-targeted CAR-T cell therapy. After CAR-T cell transfusion, he developed grade 3 CRS includes fever, dyspnea, tachycardia and hypotension. The symptoms of CRS persisted and chest plain film revealed bilateral pleural effusion. Diagnosis: Chylothorax was confirmed by the pleural effusion analysis that triglyceride level was 1061 mg/dL. Bacterial and fungal culture of pleural fluid reported no pathogen was detected. Cytological examination of pleural effusion revealed no malignant cells. Interventions: The chylothorax resolved after treatment with intravenous administration of tocilizumab. Outcomes: On 30-day follow-up, the patient was in stable clinical condition with complete remission of DLBCL on whole-body positron emission tomography scan. Lessons: We reported a rare case of CAR-T associated chylothorax in a patient with relapsed and refractory DLBCL. Grade 3 CRS with high interleukin-6 level was presented in our patient. The symptoms of CRS were improved with tocilizumab treatment and the chylothorax resolved later on. It is suggested that high interleukin-6 releases might induce chyle leakage resulting from activations of endothelium and coagulation. Our finding highlights the occurrence of chylothorax during the course of CAR-T cell therapy and the importance of proper monitoring and prompt management of this life-threatening side effect.

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Section: Discussionmentioning

confidence: 57%

Chylothorax after chimeric antigen receptor T cell therapy for relapsed and refractory diffuse large B-cell lymphoma: A case report

Chen,

Kuo,

et al. 2023

Medicine

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“…However, drug-induced chylothorax is uncommon and mainly described in association with second-generation Bcr-Abl TKI use. 4,5…”

Section: Discussionmentioning

confidence: 99%

“…However, drug-induced chylothorax is uncommon and mainly described in association with second-generation Bcr-Abl TKI use. 4,5 Dasatinib is a second-generation Bcr-Abl TKI currently approved for use in intermediate-to high-risk CP-CML and Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukaemia (ALL). Its use in CP-CML was propelled by the landmark DASISION trial in 2010 which reported superior complete cytogenetic and major molecular response in CP-CML patients treated with dasatinib as compared to imatinib.…”

Section: Casementioning

confidence: 99%

“…11 To date, the mechanism of dasatinib-induced chylothorax remains unclear, although it is postulated to be related to the inhibitory effect of dasatinib on PDGFR-β signalling, which regulates lymphangiogenesis. 4 Interestingly, dasatinib is found to be 67× more potent than the first-generation TKI imatinib in inhibiting PDGFR-β activity, 12 which may explain the absence of reports of imatinib-related chylothorax.…”

Section: Casementioning

confidence: 99%

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